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2013 PQRS

Jenny Posted Mon 16th of February, 2015 15:43:53 PM

I was wondering where I could find "to the point" penalties for non-participating providers back in 2013 incentive program ? I voiced my concern for participating in it back then, and my provider declined. Well, now that the penalties are starting to come in-he wants to know why are some penalties taken off a group EOB, and why some are just randomly picked. Meaning, is there a method to their maddness???

SuperCoder Answered Mon 16th of February, 2015 17:10:44 PM

Thanks for your question. There is a method to their madness. CMS has created a map to assist providers in understanding the 2015 payment reductions. This will assist you in narrowing down the reductions based on the EHR meaningful use, value modifiers, and PQRS requirements. Take a look at the following CMS links. They will provide information regarding the payment reductions and how to prevent future reductions on the 2016 claims. Hope this helps.

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Understanding-2015PaymentAdjustment.pdf

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