Act now to avoid Medicare payment reductions of up to 9%

 In Meaningful Use, PQRS, Value-Based Modifiers

Pay-for-performance has become a reality. As much as 9% of your Medicare payments may be at risk based on your participation in Medicare’s three provider-based quality initiatives in 2015. In this Vital Stats, we review what’s at risk and what actions you need to take now to avoid future pay cuts.

Meaningful Use

What’s at stake?

A 3% reduction in 2017 Medicare payments, and loss of EHR Incentive payments ($2,000-$8,000 per provider)

What’s the deadline?

The last possible reporting period is 10/2/15 to 12/31/15. Attestation will open January 1 and must be completed by February 29. Providers may apply for a hardship exemption until July 1, 2016.

Actions to take now:

  • Understand the recent changes to the MU program, which significantly REDUCED the requirements. If you previously planned to give up on MU, take another look. Read our summary here. FAQ 12985 provides details regarding Public Health reporting exclusions for 2015.
  • Still required is an annual HIPAA Security Risk Assessment. If you haven’t completed one for 2015, now is the time. Need help? We recommend HIPAA Secure Now. MSOC clients receive a 15% discount.
  • Prepare for an audit. Retain documentation for at least six years. Your documentation should support your response to each measure and CQM. It should include screenshots, EHR reports, your dated Security Risk Assessment and detailed explanations for any measure exclusions.

Physician Quality Reporting System (PQRS) & Value-Based Modifier Program (VBM)

What’s at stake?

For practices with less than 10 providers – 4% reduction in 2017 Medicare payments (2% PQRS, 2% VBM). For practices with 10 or more providers – 6% reduction (2% PQRS, 4% VBM).

What’s the deadline?

Report quality measures by February 29, 2016 on services provided January – December 2015.

Actions to take now:

  • Individual measure reporting (claims, registry, QCDR): Review data reports to ensure that you will be submitting information on over 50% of Medicare patients eligible for each of 9 measures. Selected measures must cover three domains, and one must be from the cross-cutting list.
  • EHR reporting: Contact the EHR vendor to confirm their capability to assist with submitting CQM data electronically for both MU and CQM. Obtain EIDM login and access to the PQRS submitter role on the PV-PQRS portal.
  • Measure group reporting: Identify sample of 20 patients; complete chart reviews and ensure performance rates are greater than 0% on each measure; proactively capture data on patients seen in December if needed.
  • Practices with 10 or more providers: Work to increase performance rates on the measures you will report. Practices with quality scores significantly above average will earn higher Medicare payments in 2017, while those with scores significantly lower than the average will have reduced rates.

MSOC Health offers consulting services to assist practices in navigating Medicare’s pay-for-performance programs. Contact Jeanne Chamberlin at 919-442-2422 or

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