Pathology/Lab Coding Alert

Deadlines rush your lab clients to EHR, too.

With more than enough pay cuts to go around, nearly anything your lab can do to hold on to earnings is a step worth taking. 

Read on to make sure you know what’s happening with certain Medicare program options, such as the Physician Quality Reporting System (PQRS), that could impact your bottom line. 

Look for PQRS Penalty Notifications

The 2013 PQRS incentive program feedback reports are currently available if you’re interested in reviewing yours, said CMS’s Christina Phillips during a recent Open Door Forum call. “There are two different types of reports you can access—one is the NPI identifier level report, the other is a PIN-level report,” Phillips said. An authorized representative will have to sign in to access the report. For more information on the feedback reports, visit the PQRS website at www.cms.gov/pqrs.

In addition, Phillips said, starting in late October or early November, CMS will send notification letters to providers who are subject to the 2015 PQRS payment adjustment. Whether an eligible professional (EP) is subject to this penalty (which equals 1.5 percent of your Medicare fee-for-service payments) will depend on the reporting you did in 2013, “so it is important that you access your feedback reports and determine your level of reporting,” she said.

Way out: If you are notified that you’ll be facing the 1.5 percent PQRS penalty in 2015, keep in mind that the penalty increases to two percent in 2016. If your group practice is hoping to avoid that two percent hit, you do have options, said CMS’s Sabrina Ahmed during the call. 

“In 2016, Medicare will apply a modifier to physician payments under the Fee Schedule for physicians in groups with 10 or more eligible professionals,” Ahmed said. “2014 is the performance period for the value modifier that will be applied in 2016. Groups with 10 or more EPs in 2014 can avoid the automatic negative two percent value modifier payment adjustment in 2016 by participating in the PQRS group practice reporting option (GPRO) in 2014 and meeting the satisfactory reporting criteria.”

Embrace Rising EHR Use

If you’ve been working to interface your lab information system (LIS) with client electronic health records (EHRs), you can expect to see a spike in the action. 

That’s because the clock is also ticking for the EHR incentive program, according to CMS’s Elizabeth Holland during the call. “All providers, even those in their first year, have until Feb. 28, 2015 to attest and earn a Medicare incentive for 2014, which is the last date to attest and earn an incentive.” If you do not successfully demonstrate meaningful use, you’ll face a one percent adjustment in your Medicare payments.