Majority of doctors may face penalty over Medicare quality reporting

A development report from the Centers for Medicare Advantage Plans & Medicaid Services shows that less than 200,000 physicians, out of the more than 600,000 who were entitled for the incentive program, reported Medicare’s physician quality reporting system (PQRS) measures in 2010. It was found that more than 125,000 physicians reporting as individuals fulfilled sufficient requirements to share a total of nearly $400 million in bonuses, but many eligible doctors did not make any effort to meet the pay-for-reporting criteria.

The absence of involvement on the part of the physicians may lead CMS to not only withhold bonuses from doctors who don’t take part in the Medicare Plan’s PQRS but also deducting their pay rates. Physicians may consider 2012 to be their final year to try reporting risk-free: A 1.5% noncompliance fine won’t be evaluated until 2015, but that payment adjustment will be based on whether physicians report quality measures in 2013.

Organized medicine groups, including the American Medical Association, have recommended CMS not to base 2015 Medicare Supplement Plan’s PQRS penalties on the 2013 reporting year. According to AMA President Peter W. Carmel, MD, physicians are facing various time limits for penalties associated with quality and health information technology initiatives. The programs require doctors to meet considerable requirements to stay away from the penalties.

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