In July, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. This rule includes proposed changes to the three major quality reporting initiatives associated with Medicare PFS payments: the Medicare Electronic Health Record Incentive Program (i.e., meaningful use or “MU”), Physician Quality Reporting System (PQRS), and Physician Value-Based Payment Modifier (VBM). In this proposed rule, CMS also begins implementation of the new Merit-Based Incentive Payment System (MIPS), as well as a number of other policies required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed in April.
This proposed rule is now open for public comment and after public comment, a final rule will be issued that will impact Medicare payments to physicians starting January 1, 2016.
(See here and here for more details.)
Impact for NextGen Healthcare clients: As proposed, this rule furthers the process of tying reimbursement to quality and to participation in MU, PQRS, VBM and other quality programs. Non-compliance with these three programs in 2016 could result in a 10% Medicare penalty during the 2018 payment period. NextGen Healthcare supports our clients’ compliance with the MU, PQRS, VBM, and other quality reporting programs with our certified EHR and ancillary solutions, including the NextGen® Health Quality Measures (NextGen HQM) for quality reporting. To get NextGen HQM, simply log a ticket with NextGen HQM implementation. The proposed rule also includes new payment codes for advance care planning, and we encourage you as appropriate to complete the advance directive templates in the NextGen® Knowledge Base Model (NextGen KBM) so that you will be able to bill for these new codes once they become finalized.