Summary of Key Provisions in 2015 Medicare Physician Fee Schedule Final Rule
Avoid the 2016 PQRS Medicare Claims Penalty:
To avoid being penalized 2% on all of your 2016 Medicare claims, you must have reported the necessary quality measures pertinent to psychiatry for at least 50% of your eligible patients by December 31, 2014. If you did not fulfill the PQRS (Physician Quality Reporting System) requirements for reporting on quality measures in 2013 (only one measure needed to be reported that year) you will receive a 1.5% downward adjustment on all of your Medicare claims in 2015.
2015 Proposed Medicare Physician Payment Fee Schedule
New information posted on the quality initiatives in the 2014 Proposed Medicare Physician Fee Schedule and what these will mean for your future. A flow chart illustrates how the various components can combine to affect the physician payment.
Received a Revalidation Request Letter? Now What?
Have you received the yellow envelope containing a request to revalidate?
• Prevent payment hold and deactivation of billing privileges by responding timely.
• Submit a completed revalidation application as soon as possible, but no later than 60 days from the postmark date on the revalidation request letter.
Do you want to revalidate using the quickest and easiest method?
• Use PECOS
• Submit your revalidation via the Internet-based secure Provider Enrollment Chain & Ownership System (PECOS) rather than a CMS-855 paper application. The process is as easy as verifying your information in PECOS, making changes where needed, uploading supporting documents, and signing the application electronically.
• For details and helpful tips, visit the Enrollment section of your Medicare Administrative Contractor's website. [Web links are vailable on the MAC Directory]
So you have never used PECOS or haven't accessed PECOS lately?
• Get started and revalidate in PECOS.
2% Sequestration Medicare Fee Cut:
As of April 1, 2013, Medicare fees were effectively cut by 2% as part of the overall federal cuts required by sequestration. For participating providers, patients will still be required to pay the same copay they paid before sequestration (even though the percentage of the total will be slightly higher than it was since the amount received from Medicare will be lower), but the provider will receive 2% less from Medicare. Nonparticipating providers may continue to charge patients the limiting charge for the service, and the 2% will be subtracted from the reimbursement they get from Medicare.
Medicare was created in 1965 as part of the Social Security Act. The program was divided into two parts. Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice. It covers the room, board, and ancillary charges billed directly by the facility. Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. Since 2006 there has also been a prescription drug benefit that Medicare beneficiaries can buy into known as Medicare Part D.
Practice help is available to Members through the Practice Management HelpLine by phone [800.343.4671] or email us at firstname.lastname@example.org.
More online/print practice resources supported by OHSF:
Quick Practice Management Guides – Documents exploring common practice management issues encountered by psychiatrists.
Practice Management for Psychiatrists: The Basics The e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing. Free online to Members.
Information on Mental Health Parity can be found on the APA website www.psych.org under Managing A Practice or on the APA co-sponsored site www.parityispersonal.org.