Government Incentives for Medical Practices: Tips and Tools to Qualify, Participate and Get Paid #2

Kathy McCoy, MBA May 21st, 2012

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Practitioners who accept either Medicare or Medicaid need to pay careful attention to programs offering government incentives for medical practices that have carrot-and-stick provisions over the years to come

If you think being compensated fairly for your services is getting more complicated, you aren’t imagining things. Any practitioners who accept either Medicare or Medicaid need to pay careful attention to three government programs that have carrot-and-stick provisions over the years to come. That was the message from noted medical billing guru and author Elizabeth Woodcock, MBA, FACMPE, CPC during her webcast, presented on behalf of Kareo. In Government Incentives for Medical Practices: Tips and Tools to Qualify, Participate and Get Paid, Elizabeth summarized programs that can help practitioners to earn additional compensation through the Affordable Care Act.  Her presentation also covered “voluntary” incentive programs that carry penalties if practitioners decide not to participate.  Read on for important highlights from her webinar.

There are three programs that carry bonuses or penalties, depending on your successful participation.  They are the Electronic Prescribing (eRx) Program, the Physician Quality Reporting System (PQRS), and the Electronic Health Record (EHR) Incentive Program. During her webinar, Elizabeth first discussed the penalties and bonuses associated with nonparticipation in the eRX program. Practitioners can avoid eRX penalities in 2013 if they generate ten G8553 codes by June 30, 2012. The code indicates that at least one prescription was created during the encounter, and was generated and transmitted electronically using a qualified eRx system. By submitting 25 G8553 codes by December 31, 2012, practitioners can avoid the penalty in 2014 as well and qualify for a 1 percent bonus payment, based on a percentage of total Medicare allowed charges. Other restrictions and guidelines on this program can be found at The MGMA asked CMS to extend the eRX penalty to December 31, 2012, on May 16. It’s unknown whether CMS will do so.)

Participation in PQRS can earn clinicians up to a 1 percent bonus yearly if they participate in 2012, 2013 and 2014. A penalty of 1.5 percent is levied for non-participation starting in 2015 and increases to 2 percent in 2016. Physicians must decide how, what and when to report into PQRS. They also need to integrate the associated codes into their workflow. More information, including how the maintenance of certification program works into the bonus payment, can be found at

The Electronic Health Record (EHR) Incentive Program is actually two separate programs with differing payouts and requirements for meaningful use of the EHR. Clinicians can only participate in one. Medicare’s program is based on fee-for-service allowed professional charges, up to an annual cap. It pays up to $44,000 over five years, and requires 90 days of meaningful use of the EHR in the initial payment year. Meaningful use must be ongoing every year afterward. Medicaid’s program requires that at least 30 percent of a clinician’s patient volume must be must Medicaid insureds (20 percent for pediatricians). The program pays a flat bonus of up to $63,750 over six years. It does not require meaningful use in the initial payment year, only that participants engage in “adopting, implementing or upgrading” a certified EHR system. More information can be found at

One important note: Although you must participate to avoid the penalties, you give up the eRx bonus if you are a successful participant in the EHR Incentive Program through Medicare. That doesn’t mean you can stop generating the eRX G8553 codes—the government will penalize you if you don’t participate in the eRX program, even if they are not giving you the bonus payment. Be sure you keep generating those codes, even if you are not receiving incentive payments.

Several government incentive programs for medical practices carry penalties if practitioners decide not to participate

Kareo regularly sponsors timely, informative webinars such as this one to keep physicians and medical billers up to date on matters related to billing, coding, compensation and practice management.

You can view our archived webinars to find more topics of interest to you. To be notified about upcoming informative webinars such as this one, join our newsletter list. Sign up now for our next webinar on Using RVUs to Improve Your Bottom Line.

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