Coding Corner: CPT reporting for preventive medicine services

August 20, 2015
Area(s) of Interest: Advocacy Electronic Health Records Health Information Technology 

With physicians potentially facing large penalties for meaningful use and other Medicare reporting programs, the California Medical Association (CMA) is urging the California members of Congress to cosponsor the American Medical Association's meaningful use (MU) reform legislation, H.R. 3309, “The Further Flexibility in HIT Reporting and Advancing Interoperability Act” (FLEX IT 2 Act) and to immediately move the bill.

“Physicians are facing a tsunami of Medicare regulations that threaten the viability of our practices," said CMA President Luther F. Cobb, M.D. "H.R. 3309 would provide some important flexibility and sanity in the meaningful use program while advancing interoperability. Medicare could see a significant decline in physician participation and access to care if these bureaucratic programs are not reformed.”

Recently, the Medicare program made a stunning announcement that while 78 percent of physicians are using an electronic health record (EHR) – particularly in California, where physicians have been early adopters – more than 50 percent of eligible physicians will face meaningful use penalties under the EHR Incentive Program in 2015. The Medicare EHR Incentive program was intended to increase physician use of technology to improve care and efficiency. Unfortunately, the program's unrealistic and unnecessary requirements are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupt workflow, interfering with patient care and imposing administrative burdens.

H.R. 3309 addresses the following problems in the meaningful use program:

Eliminates the all-or-nothing approach. Under the current system, physicians who meet anything less than 100 percent of the measures are hit with a financial penalty. It imposes the same penalty on a physician who has met 99 percent of the requirements as a physician who does not attempt to participate in the program at all. H.R. 3309 will recognize the differences in specialty measures and provide credit on a sliding scale that incentivizes physicians to participate and continue improving.

Aligns quality reporting requirements across Medicare programs. H.R. 3309 streamlines the reporting requirements across Medicare's various quality reporting programs and deems physicians who have successfully met physician quality reporting system (PQRS) goals to have satisfied the MU quality requirements.

Delays stage 3 requirements. To improve physician participation, stage 2 needs to be reformed and successfully completed by physicians before stage 3 begins.

Expands the hardship exemption. The bill provides exemptions for physicians subject to disruptive technology problems, including physicians who change EHR products. It also provides exemptions for certain physicians who are close to retirement and recognizes specialties that do not directly interact with patients.

Shortens the reporting timeline. The bill institutes a 90-day reporting period to remove barriers to interoperability and promote usability. The current 365-day reporting period limits innovation, leaving physicians with no downtime to upgrade products, improve usability and test innovative solutions.

Advances interoperability. The bill ensures that EHRs are interoperable—capable of sending, receiving and incorporating data through repeated testing and evaluation by end users. It also provides flexibility so that physicians are not liable for EHR products that are not interoperable.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmadocs.org.


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