Medicare’s Quality Improvement Program – Information for Physiatry

Starting in 2017, CMS has instituted a Quality Payment Program (QPP) which incorporates prior PQRS/EHR programs.

Under the new QPP program, all Medicare Part B clinicians are responsible to report various categories:

  1. Quality(old PQRS)
  2. Advancing Care(old EHR)
  3. Improvement Activities, and
  4. Cost(begins 2018)) as follows:

-All physicians must report, whether they are solo practitioners, or employed by another entity.

-Clinician must have more than $30,000 in Medicare allowed charges AND must provide care to more than 100 Medicare patients a year, or they are exempt,

-Clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

-Newly enrolled physicians are exempt during their first year of practice.

Penalties will be assessed as follows:

Failure to properly report in 2017 will cause a 4% penalty in 2019.

Failure to properly report in 2018 will cause a 5% penalty in 2020.

Failure to properly report in 2019 will cause a 7% penalty in 2021.

Failure to properly report in 2020 will cause a 9% penalty in 2022.

Incentives are also available for the above years for successful reporting:

Successful reporting in 2017 may result in an incentive of up to 4% in 2019.

Successful reporting in 2018 may result in an incentive of up to 5% in 2020.

Successful reporting in 2019 may result in an incentive of up to 7% in 2021.

Successful reporting in 2020 may result in an incentive of up to 9% in 2022.

This information was provided by Bruno Stillo, CPA, MBA, Physiatry Billing Specialists,

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