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Avoid Medicare Penalty In 2019: What Physicians Need To Know

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Avoid Medicare Penalty In 2019: What Physicians Need To Know

 

Medicare Penalty

Many healthcare providers have previously decided to accept the various Medicare penalties because they just didn’t see the value to spend the time and energy necessary to meet Medicare’s reporting requirements. The all or nothing nature of PQRS and Meaningful Use meant that providers might be subject to a penalty for some seemingly trivial reason even after they did devote significant time and energy to compliance. The lack of feedback with claims based reporting led many providers to be subject to a penalty even after diligently submitted PQRS information on their claims for the entire year.

Things have changed significantly with the roll-out of MACRA effective January 1, 2017. To begin with, small volume providers are completely exempt from penalties (or incentives). It’s no longer an all or nothing system. Penalties and incentives will be calculated based on how providers compare to their peers. It’s too late to do anything about the penalties in 2017 and 2018 but it will take little effort to avoid the 2019 penalty by meeting very simple requirements in 2017.

Also, providers can qualify for 2019 incentives by participating for only 3 months during 2017. Beginning in 2018, providers will have to participate for a full year to avoid penalties or qualify for incentives.

The penalties are becoming stiff enough that it will become more and more cost effective to participate. In addition, commercial payers will begin to follow Medicare’s lead at some point. It is probably beginning to make sense for providers to spend the necessary capital to participate.

The Basics

For 2017, there are a few key things that you’ll need to do in order to avoid being given a Medicare penalty once 2018 rolls around. It’s actually much easier to meet these requirements than some other compliance related guidelines. Essentially, you’ll need to meet one of two qualifications:

  • Submit a single quality measure for one patient at some point during the year. Or
  • Take one MIPS related action at some point throughout 2017.

That’s it in a nutshell. By doing either of these two things you can avoid facing a Medicare penalty and keep yourself on the right side of compliance.

Earning A Bonus

You can also go beyond avoiding a penalty and actually earn a bonus when you participate fully in MIPS for a minimum of 90 days during the year. Then, during the next year if you participate for the duration of the year you can earn a bonus and improve your bottom line in the process.

It’s important to note throughout all of this that providers who have fewer than 100 patients in a year or who have less than $30,000 in allowable charges will be exempt from MIPS and thus won’t need to concern themselves with it in the least.

At WWS, we understand not only how important it is to avoid penalties, but how to help you stay compliant where any billing issue is present, so feel free to contact us today to find out more about what we can do for you.

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