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Medicare Incentive Payment Programs for Providers

There are opportunities for certain Medicare providers to receive incentive payments for participating in Medicare initiatives. A guide, entitled An Introduction to the Medicare EHR Incentive Program for Eligible Professionals identifies incentive programs and ways that Medicare providers can maximize their overall Medicare payments by becoming a participating provider. “The benefits of Medicare participation include higher reimbursement compared to those providers who do not participate, direct payments to the Medicare provider because the claims are always assigned, and automatic forwarding of claims information to Medigap insurers.”

Physician Quality Reporting System (PQRS)
This site helps you to determine:

  • If you are eligible to participate for purposes of the PQRS incentive payment and payment adjustment. It provides list of medical care professionals considered eligible to participate in PQRS.
  • Which PQRS reporting method best fits your practice. PQRS has several methods in which measure data can be reported. An eligible professional may chose to submit data to CMS via: claims-based, registry-based, qualified Electronic Health Record (EHR), or the Group Practice Reporting Option (GPRO).
  • Which measure reporting option (individual measures or measures group) best fits your practice. Review the specific criteria for the chosen reporting option in order to satisfactorily report.
  • Which clinically applicable measures to submit to qualify for a PQRS incentive payment.
  • Review information on the PQRS Payment Adjustment.

Medicare’s Physician Feedback/Value-Based Modifier Program
This program provides comparative performance information to physicians as one part of Medicare's efforts to improve the quality and efficiency of medical care. This is achieved by providing meaningful and actionable information to physicians so they can improve the care they furnish, and by moving toward physician reimbursement that rewards value rather than volume.