Meaningful Use

Avoiding Program Year (PY) 2015 CMS Negative Payments Applied in 2017

It’s not too late to avoid the CMS Stage 2 Meaningful Use negative payments for Program Year (PY) 2015 that will be imposed with payments issued starting in January, 1st, 2017.

On January 29, 2015, CMS announced its intention to issue a new rule in early spring 2015, which would change the Meaningful Use (MU) reporting period for Stage 2 from a full calendar year to a 90 day calendar quarter in 2015. This change is great news for Eligible Professionals (EP) that have not yet been able to implement all the requirements to meet MU Stage 2 guidelines. An important point to note is that CMS negative payments are imposed two (2) years after the calendar year (CY) in which the services took place. In early January 2015, thousands of EPs were surprised with the first negative payments for non-participation issued by CMS for services provided during Program Year (PY) 2013.

Providers have a great opportunity to implement the requirements needed to meet MU Stage 2 criteria for 2015 and collect the eEHR data needed to meet the new 90 day reporting period during the last quarter of 2015, and most importantly; avoid the penalties. But they must be proactive and act now. There are a number of new requirements for MU Stage 2 that require implementation and planning in order to meet MU Core and Menu measures.

Some of the new requirements are but not limited to:

  • Correct certified version of EHR software technology installed to track Stage 2.
  • Upgraded workflows and settings for the Patient Portal fully operational to meet higher communication thresholds for Stage 2.
  • Develop workflows and Implement the ability to incorporate lab results into patient charts.
  • Must have the ability to import imaging results and associated reports into the patient’s EHR record.
  • Must have the ability to transmit using QRDA III, to CMS by 12/31/15.

 

In touching on the consequences of non-compliance, the penalties for failing to attest are considerable. Most importantly, penalties for each program and subsequent years are cumulative and could add up to a negative 17% in some cases.

Below is a summary of current CMS Medicare Program penalties for non-participation.

MU incremental negative payments up to 5% in subsequent years

PY 2015 reduced starting with attestation in CY 2016, imposed in CY2017 – 3%

PQRS – All Groups and EPs – Negative Payment Adjustments

-2.0% Applied starting January 1st, 2017 for services during CY 2015

-2.0% Applied to each subsequent year

Value Based Payment Program – Groups 10 – 99 EPs submitting claims under a single Tax ID

-2.0 Applied starting January 1st, 2017 for services during CY 2015

Value Based Payment Program – Groups >100 EPs submitting claims under a single Tax ID

-4.0 Applied starting January 1st, 2017 for services during CY 2015

Value Based Payment Program – Solo Practitioners, first year this category will get negative payments

-2.0 Applied starting January 1st, 2017 for services during CY 2015

 

Note: All negative adjustments are cumulative by program and year.

 

For example, a solo practitioner failing to attest to all 3 programs during PY 2015, can expect to start receiving a negative 7% penalty applied to Part B reimbursements starting in 2017, and negative 9% for groups of >100 working under a single tax ID. This negative payment is in addition to any penalties for non-participation in prior or subsequent years and are not eliminated for compliance and subsequent years.

 

There is no question that these penalties can adversely impact the cash flow of any provider, especially those with a high Medicare patient mix. There is a very small window of less than 5 months to prepare, implement, test and successfully generate valid MU data for the last full quarter of 2015, however, time is of the essence, and for EPs that lack the in-house resources to comply with minimum requirements for MU Stage 2, this is the time to implement a plan and seek assistance to avoid CMS negative payments for Program year 2015.