More Health Reform Provisions Start Jan. 2

Several provisions of the Affordable Care Act (ACA) go into effect starting January 1, 2011; they include:

  • Elimination of the deductible and co-insurance for most preventive services
  • Coverage of an annual wellness visit providing a personalized prevention plan
  • Incentive payments to primary care practitioners for primary care services
  • Incentive payments for major surgical procedures in Health Professional Shortage Areas
  • Physician self-referral disclosure requirement for certain imaging services
  • Multiple procedure payment reduction policy for therapy services
  • Reduction of the maximum period for submission of Medicare claims to not more than 12 months (applies to services furnished after Jan. 1, 2010)

ACA's rules also implement changes to the structure and function of the Physician Quality Reporting System (PQRS). Under the ACA, the PQRS incentive payments are authorized through 2014, with penalties thereafter for eligible professionals who do not satisfactorily report data on quality measures. For 2011, physicians and other eligible professionals may earn an incentive payment of 1.0% of the practice's total Medicare Part B allowed charges for covered professional services furnished during the reporting period. PQRS incentive payments of 0.5 percent are auhorized for years 2012 through 2014.

CMS has created an informal review process for eligible professionals who wish to have CMS review its determination.  Eligible professionals may qualify for an additional 0.5% incentive beginning in 2011 if they satisfactorily report data through a Maintenance of Certification program

CMS is also establishing the framework for a new Physician Compare web site and is developing a plan to integrate its reporting on quality measures under PQRS with the reporting elements required by the Medicare Electronic Health Record Incentive Program.

 Finally, CMS has made revisions to its Electronic Prescribing Incentive Program, such as clarifying that physicians and other eligible professionals who receive incentives under the Medicare EHR Incentive program for 2011 must still participate and meet the eRx payment adjustment requirements for successful e-prescribers under the eRx Incentive program during the applicable reporting period to avoid the payment reduction applicable in 2012. Eligible professionals who receive incentives under the Medicare EHR Incentive Program for CY 2011 may not receive a separate, additional incentive payment under the eRx Incentive Program

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