Last chance to avoid Medicare payment penalty in 2015

Visit the Quality Improvement Programs section of APAPO’s Practice Central website for helpful resources and information.

By Government Relations staff 

Medicare providers who are not yet participating in Medicare’s Physician Quality Reporting System (PQRS) must begin doing so before the end of 2013 or face payment penalties beginning in 2015. Practitioners have until Feb. 28, 2014, to submit a claim with a reported service that was provided during the calendar year from Jan. 1-Dec. 31, 2013. 

Psychologists participating in PQRS for the first time will only need to report one service measure for at least one applicable patient in 2013 in order to avoid penalties in 2015. Providers who already participate in PQRS are required as usual to report on 50 percent of applicable Medicare cases in 2013. 

In 2013 and 2014, psychologists who successfully participate in PQRS will earn an additional 0.5 percent payment on all of their Medicare charges. Successful participation requires reporting on at least 50 percent of applicable Medicare cases and selecting measures that are appropriate for the patient and service provided.

Beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will no longer provide bonuses but instead will impose penalties on those who do not successfully report PQRS measures. The payment penalties will be 1.5 percent in 2015 and 2 percent in 2016. Because PQRS is set to become a penalty-based program, Medicare must operate prospectively in order have the time needed to analyze reporting data before applying any payment adjustments. The 1.5 percent penalty adjustments for 2015 will be based on 2013 reporting data, while the 2 percent penalty for 2016 will be based on 2014 reporting data. Penalties will apply to all Medicare charges by a provider.

Psychologists who do not find any of the measures to be applicable to their services and/or patient population are advised to contact the CMS QualityNet Help Desk for assistance. The QualityNet Help Desk is available Monday through Friday, 7 a.m.-7 p.m. CST, by telephone at (866) 288-8912 (TTY (877) 715-6222). Inquiries may be sent by email.

More information, including a list of measures that psychologists are eligible to report, instructional videos and FAQs, visit the Quality Improvement Programs section of the APA Practice Organization’s (APAPO) Practice Central website.