Maximizing 2019 Medicare Part B payments

Three ways to maximize your Medicare Part B payments in 2019

On average, oncologists receive $316,425 in Medicare Part B payments each year.*

A physician who did not report PQRS or attest to meaningful use in 2015 will see a 9 percent cut in Part B payments in 2017; failure to report and attest in 2016 means the same for 2018.

  • A 2 percent cut for not reporting PQRS
  • A 4 percent cut for the physician value modifier
  • A 3 percent cut for meaningful use

For the average oncologist, that means leaving $28,478 per year on the table in 2017 and 2018.

For 2017, PQRS and meaningful use have been replaced with the Merit-Based Incentive Payment System – MIPS – with new reporting requirements across three categories of performance measures:

Quality + improvement activities + advancing care information = MIPS score

Failure to report in 2017 will mean a 4 percent cut in Part B payments in 2019.  For those physicians who elect not to participate, they will receive 5 perecent more in Part B payments than they will receive this year due to failure to report PQRS/attest to meaningful use in 2015.

With minimal effort, however, physicians can avoid the 4 percent MIPS penalty for 2019.

Under CMS’ "Pick Your Pace" program, by completing just one of the options below, physicians or group practices will not be assessed a MIPS penalty, meaning 9 percent more in Part B payments for those who did not report/attest in 2016:

Report performance on one quality measure over a 90 day period.

Example:
Oncology: Medical and Radiation – Pain Intensity Quantified

  1. Determine all patients that are undergoing chemotherapy and radiation therapy
  2. Of those patients, determine the number of patients who received a plan to manage experienced pain

This is one of nearly 300 quality measures from which to select

Attest to performing one improvement activity for 90 days.

Example:
Provide 24/7 access to care team members

  1. Have a phone number for patients to call a care team member 24/7
  2. Ensure remote access to your EHR
  3. Document this access and attest to the measure

This is one of more than 90 improvement activities from which to select.

Attest to meeting four advancing care information measures.

  1. Conduct EHR security risk analysis
  2. Use e-prescribing for at least one patient
  3. Provide patient electronic access for at least one patient
  4. Send electronic summary of care to another clinician for at least one patient

For more potential measures to avoid penalties in 2019, visit qpp.cms.gov.

Sources:
*From the MGMA Cost and Revenue Survey based on 2015 data