New CMS and ACA Deadlines in 2014 for Physicians

Physicians will need to be on the outlook for a number of deadlines in 2014 coming from the Centers for Medicare and Medicaid Services (CMS), as well as a result of the Affordable Care Act (ACA). The deadlines pertain to the areas of quality of care, electronic health records and coding.

On Jan. 1, stage 2 of the CMS meaningful use incentive program began for eligible providers (EPs) who treat Medicare and Medicaid patients. EPs have until Oct. 1 of this year to demonstrate meaningful use and must do so for only a three-month period. Once the stage 2 requirements are met, Medicare EPs will receive a payment of $12,000 in 2014, and Medicaid EPs will receive $21,250. EPs who do not meet the deadline face penalties from 1 percent to 2 percent in 2015.

Also on Jan. 1, states that comply with expanded access to Medicaid as called for by the ACA must extend Medicaid to children and adults with a family or individual income that is less than 133 percent of the federal poverty level. Under the program, Medicaid payments will be raised to 100 percent of Medicare reimbursements for doctors who take on these patients. However, the incentive payments stop at the end of 2014, so those doctors who didn’t sign up for the program in 2013 should plan to enroll early in 2014.

The reporting deadline for physicians to qualify for a 0.5 percent bonus for their participation in the Physician Quality Reporting System (PQRS) is nearing. Only physicians who signed up for the PQRS by Oct. 18, 2013, are eligible to qualify for this bonus. Those who submit performance data through Medicare claims or their electronic health record systems must do so by Feb. 28. Those who submit data through a patient registry have until the end of March. Physicians who failed to sign up for the PQRS by Oct. 18, 2013, will pay a penalty consisting of a 1.5 percent reduction in Medicare reimbursement in 2015.

March 31 is the deadline for physicians who do not qualify for Medicare or Medicaid and for those who are self-employed or who are small business owners to purchase plans in the insurance exchanges for themselves, their families and their employees. Those who fail to sign up for coverage must pay a tax at the end of the year.

Oct. 1 is the deadline for physicians to be up to speed and in compliance with the ICD-10 coding system, which contains 68,000 diagnosis codes (about five times the number found in ICD-9). Last, Jan. 1, 2015, is the deadline to meet the care criteria under CMS’s Medicare Physician Fee Schedule, which will include cost and quality data in calculating payments for physicians. The new payment structure will emphasize value of care as opposed to volume of care, and physicians who do not meet the care criteria will be penalized. By 2017, this value-based payment modifier will be applied to all physicians who bill Medicare for services provided under the physician fee schedule.