1. E-Prescribe or Be Penalized
If you start writing electronic scripts in 2013, you could still receive a bonus of 0.5% from CMS. If you didn’t electronically write at least 10 prescriptions in the first 6 months of 2011, you lost 1% of your Medicare reimbursement in 2012 (unless you qualify for a “hardship exemption”; deadline: January 31, 2013). The fine increases to 1.5% in 2013 and to 2% next year.
If you already have and use an e-prescribing system, February 28 is the last day to submit claims to reap the 1% bonus payment for Medicare patients whose prescriptions were successfully sent to a pharmacy electronically in 2012.
2. Begin Meaningful Use to Avert Penalties
If you can show meaningful use, February 28, 2013, is the last day to complete attestation for payment year 2012. 2013 and 2014 are the last years that eligible professionals (EPs) who see Medicare or Medicaid patients can earn incentive payments. If a Medicare EP qualifies to receive a first payment in 2013, the amount is $15,000. In 2014, it’s $12,000. If a Medicaid EP qualifies for an initial payment this year or next, the amount is $21,250.
If you see Medicare or Medicaid patients and fail to meet meaningful use requirements, there are penalties: probably 1% in 2015, rising to 3% in 2019.
3. Start Meeting Medicare Quality Performance Targets
In 2013, CMS will gather performance data to determine which doctors will get award bonuses and which will get a 1.5% cut in Medicare payments starting in 2015.
CMS is testing a physician performance program using data gathered in its Physician Quality Reporting System (PQRS) initiative, which promotes reporting of quality information by EPs. This feedback will be combined with claims-based efficiency data to develop a “value-based modifier” that will result in different Medicare rates being paid to individual physicians.
4. Gear Up for Value-Based Purchasing
Built upon the PQRS model that promotes reporting by doctors, as well as data from other programs, CMS’s value-based purchasing program links reimbursement directly with care quality. A value-based modifier (VBM) will adjust Medicare reimbursement up or down on the basis of a physician’s efficiency and quality scores.
The 2015 VBMs will be based on performance 2 years prior to the year in which incentives or bonuses are paid or penalties levied. Based on benchmarks, high-quality, low-cost groups would receive up to a 3% bump in their Medicare payments; underperforming groups would lose 1% of their reimbursement.
5. Tell Your Staff About State Insurance Exchanges
If you have employees, March 31, 2013, is the deadline for notifying them about new health insurance exchanges, expected to be set up by governments in about 20 states, with the federal government setting up the rest.
The deadline may be extended, but whether or not it is, you need to inform your staff about the services offered by your state’s exchange, how to contact it, the value of any coverage you offer (for the sake of comparison shopping), whether employees are eligible for a premium tax credit for a plan purchased on a state exchange, and other tax information.
6. Decide Whether to Offer Employee Health Insurance
Many physician practices don’t offer employee health insurance because of the cost. But that may no longer make economic sense. In 2014, companies with 50 or more workers that don’t cover their employees must pay a penalty of $2000 for each employee who buys government-subsidized insurance through an exchange (excluding the first 30 employees who do so). If you have a staff of 50 and they all buy insurance from an exchange, you’d pay $40,000 in penalties (20 workers x $2000 each). It may or may not be less expensive to offer staffers employer-sponsored coverage. In 2013, make your decision.
7. Consider Taking Medicaid Patients
Under the Affordable Care Act, primary care physicians already receive a Medicare bonus of 10% that will continue through 2015. But many primary care doctors are loath to take Medicaid patients, generally due to lower reimbursement.
2013 may be the year to rethink that decision. Medicaid payments will be raised to 100% of the Medicare fee schedule in 2013 and 2014. Affected specialties include family medicine, internal medicine, and pediatrics. In some states, primary care doctors who treat Medicaid patients will see their rates jump significantly. To boost your bottom line, it’s worth considering.
8. Get Up to Speed on ICD-10 Coding
CMS has delayed the deadline for healthcare organizations to convert to the ICD-10 coding system to October, 1, 2014. But you can’t kick back and relax. Taking time now to learn about ICD-10 codes will significantly affect how the transition affects your practice.
Don’t underestimate the scope and complexity of the transition. According to the Healthcare Information and Management Systems Society, a smooth, successful transition requires a well-planned and well-managed implementation process that could take as much as 2 years.
9. Review Your Employer’s Rules on Extracurricular Pay
If you publish in clinical journals or consult or speak for pharmaceutical or medical device manufacturers, 2013 is an excellent time to review your workplace’s rules on how much in extracurricular fees you can ethically accept.
That’s because 2013 is probably when data collection will begin for the Physician Payments Sunshine Act, which requires drug and device manufacturers to disclose all fees and gifts valued over $10 that are given to physicians. CMS was supposed to begin data collection in 2012 and to post data on January 1, 2013. It hasn’t happened yet, but it’s wise to review those rules.
10. Write to Your Elected Representative to Protest Medicare Pay Cuts
Pay cuts for physicians are still in the offing. The Independent Payment Advisory Board (IPAB) is charged with making recommendations for Medicare cuts when cost growth exceeds a target rate. But it can’t submit proposals that would ration care, increase revenues, change Medicare benefits, or increase cost sharing. The cuts won’t come from hospitals. Who’s left? Providers. The first year that the IPAB could recommend provider payment cuts is 2014. The American Medical Association supports a House bill to repeal that provision. If you want to keep the pressure up on your elected representatives, write to your Congressperson.