Medicare Changes Take Effect July 1, 2014

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that go into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after January 1, 2014, through December 31, 2014. PAMA also provided a zero percent update to the 2015 Medicare Fee Schedule through March 31, 2015.

Previous budgetary restrictions led to a 2% sequestration reduction in fees. Sequestration is to remain in effect through at least March 31, 2015. This means that you will continue to see a 2% reduction in reimbursement from Medicare. If you are a participating physician in the Medicare part B program, you will continue to charge the Medicare amount and collect co-pay amounts; however, you will see a 2% reduction in the amount Medicare reimburses to you. The provider is not allowed to collect the 2% from the patient. For a non-participating physician, since the patient pays the provider up front, the patient will see a 2% reduction in the reimbursement amount from Medicare.

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In addition, the Medicare fee schedule will also see another increase in chiropractic manipulation reimbursement. The Medicare demonstration project, while scoring high for chiropractic in customer satisfaction, resulted in payments that were $50 million over budget. To recoup that amount, Medicare has been reducing reimbursement for 98940, 98941 and 98942 by 2%. CMS has announced that the recouped amounts have now replaced the monetary downfall and the 2% recoupment due to the demonstration project has now ended. This will result in a 2% increase in reimbursement for chiropractic services 98940, 98941 and 98942 in the Medicare program. The fee schedule is expected to be updated on July 1, 2014. Physicians should check with their local carrier on-line for the new amounts for their locality.

Electronic Health Record Deadline Approaches

Eligible professionals have until July 1, 2014 to start using their EHR in accordance with meaningful use guidelines. If you have not begun to use electronic health records by July 1, 2014, then fines will be levied beginning in 2015. Meaningful use is for all of your patients; incentive money is based on the services you performed on active care Medicare part B patients. Meaningful users will be subject to a payment “adjustment” beginning on January 1, 2015. The reduction will increase 1% per year.

If you have a hardship, then you may qualify for a delay in the implementation of your meaningful use attestation until October 1, 2014. Eligible professionals can apply for hardship exceptions in the following categories:

Eligible professionals can apply for hardship exceptions in the following categories:

• Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
• New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.
• Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
  • 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

The 2014 EHR vendor issues may be the most likely hardship taken.

Eligible professionals may apply for hardship exceptions to avoid the payment adjustments described above. Hardship exceptions will be granted only under specific circumstances and only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving meaningful use. Information on how to apply for a hardship exception is posted on the CMS EHR Incentive Programs website at www.cms.gov/EHRIncentiveProgram

Physician Quality Reporting System (PQRS) Enters into New Reporting Period

For all providers in the Medicare Part B program, PQRS is mandatory for 2014. 50% of all eligible patients under the Medicare Part B must have the appropriate quality measures reported for 2014. If the provider does not report the meaningful use measures on at least 50% of active care patients in the Medicare part B program, then a payment adjustment (penalty) of 1.5% will be assessed in 2016. 2015 will see penalties assessed due to improper reporting, in 2013.

Chiropractors must only report on three measures:

• Pain assessment
• Functional Outcomes Assessment
• Blood Pressure

However, blood pressure must be reported at least once for each patient in the reporting period. The reporting period is listed as once per year, however, if the patient has not been seen recently, then they must have the blood pressure reported at least once between July 1, 2014 and December 31, 2014. Additional readings may be required to meet PQRS regulations.

The PQRS measures and EHR Meaningful Use are among the measures that will be applied to all providers in 2016. Many medical doctors have already experience Value-Based Modifier adjustments in 2014. Chiropractors will see their reimbursement modified in 2016.

As you can see, not keeping up with requirements will result in as much as a 5% reduction in your reimbursement. Many insurance companies have indicated that they will follow the reductions imposed under the Medicare program for each provider.

Dr. Fucinari will be presenting several classes in the coming months to aid the doctor and staff in correct compliance procedures. For an updated schedule of classes and locations, go to www.ILchiro.org or www.AskMario.com. Dr. Fucinari is a Certified Medical Compliance Specialist and a Certified Insurance Consultant. For further information on compliance audits, manuals or record reviews, please contact Dr. Fucinari at Doc@Askmario.com