Half a Million Clinicians Facing Medicare Penalties

There is bad news on the horizon for many of the medical care providers in this country.  CMS – the Centers for Medicare and Medicaid Services – recently announced that approximately half a million clinicians will be penalized this year as a result of failing to meet the Physician Quality Reporting System (PQRS) requirements two years ago.

The penalty for failing to meet those mandates is 2% of the Medicare charges filed in that year of service.  In this case, that would the 2015 calendar year.  For most, the Medicare charges totaled less than $10,000, according to CMS.  For those clinicians, the penalty would amount to no more than $200.  However, when looking at larger facilities with providers who see a great number of high risk cases, the totals for 2015 could be much higher.  Some of those clinicians will pay 2% of $100,000 or more.  That, of course, means a penalty of $2,000 or more.

The PQRS is not new.  It was launched in 2007.  But, it is widely agreed that it is a complicated reporting system and one that many clinicians really dislike.  That may mean that they will be happy to see the last of the PQRS penalties assessed next year.  As of this year, the reporting system changed, which means that, in 2019, a different penalty structure will be in place, based on the new Quality Payment Program (QPP).  We recently wrote about the QPP, and the bonuses offered to those who adapt to the program before it’s actually required date.

There are, of course, frustrations associated with the improper (or incomplete) reporting of Medicare-eligible physicians around the country.  However, many were willing to absorb the expense of the penalty in order to avoid the frustrations associated with the PQRS.  The majority of those who didn’t meet the PQRS stipulations saw fewer than 25 Medicare patients in the calendar year.  The penalty will likely amount to $100 or less, which, many argue, is a small price to pay to avoid the frustration of more Medicare paperwork.

There are services that can help with such documentation, can assist with bad debt recovery, and can help to ensure that all future CMS-assessed penalties are avoided.