Most people hate change. It’s hard and often challenging. However, change can also be an opportunistic adventure. At the end of the day, it doesn’t matter whether you like change. In the world of CMS reimbursement, change requires expanded participation… or in 2017, any participation! In short, participate or be penalized. Medicare is giving out “gifts”, and there’s no fat man running around in a red suit this time of year. No, this is literally as easy as getting a participation trophy in t-ball these days. If you do one measure—yes, just one—you don’t get penalized! Now that is not great news as the SGR was only paying us at a 2002 fee schedule to begin with BUT, 4% less than 2002 is even worse, so sit back and read on.
By doing a single measure and learning how to use the new Quality Payment Program (QPP) measures, you have successfully participated in the Merit-based Incentive Payment System (MIPS) in 2017 AND you avoid the 4% payment reduction against your Medicare claims in 2019. MIPS for Beginners (M4B) with P360 allows you to avoid penalty, participate in MIPS, and it’s as easy as 1, 2, 3…well actually 1-20 as we recommend reporting 20 encounters on a single measure and you are done. Literally one and done and you don’t have to think about QPP until next year.
What the feds are hoping is you will see how easy this is—and it is pretty freakin’ easy—and choose to go for some bonus money. The bonus money is not much, but if you see $20K worth of Medicare patients per month that is about a quarter million per year. That adds up to a penalty of $9,600. While that’s not a hell of a lot of money, it is a significant portion of a staff member’s salary or 2/3 of a new piece of equipment. It’s not gonna let you retire, but it’s not chump change either. What the feds want you to see is how easy it is to avoid the penalty and, more importantly, how much money you could earn in bonus if you participate more fully in the QPP program.
Bonus can be achieved if you successfully report over 90 consecutive days or even more money if you report on over 50% of your patients for the full reporting year. The 90 day bonus is about equal to the penalty. The year-end bonus is supposed to be even bigger depending on how many people successfully participate and how much money is left in the kitty. Kinda like Vegas, but less lights, less noise, and definitely less risky. If all you want to do is avoid the penalty then start looking now at the one measure you want to use. Go to our M4B page to get your one and done complete OR learn about the bonus options in our QPP Lunch & Learn, as they might not be as hard as you think!
About the author
Douglas J. Jorgensen, DO, CPC, FAAO, FACOFP, CAQ Pain Medicine, is founder and owner of Patient360 (a Medicare-approved PQRS entity), which was one of the original private registries when the physician quality reporting program began. He lectures nationally on billing and coding issues, as well as authors articles for peer reviewed medical journals and national newsletters. In addition to litigation consultancy and expert witness work, Jorgensen consults for the FBI, Drug Enforcement Administration, and the Office of Inspector General. With his twin brother, Ray Jorgensen, CPC, he released a best-selling healthcare reimbursement guide, “A Physicians Guide to Coding and Billing.” Jorgensen is a member of the Lewiston, Maine, local chapter.