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Act Now to Avoid E-Prescribing and PQRS Penalties

From the American Academy of Ophthalmology

In the next several months, ophthalmology practices face important deadlines for meeting e-prescribing and quality reporting thresholds. Practices that don’t begin participating – or request an exemption – in time, could face a cumulative 3.5 percent cut in Medicare reimbursement over the next two years.

  • 2 percent cut in 2014 for practices that didn’t e-prescribe at least 10 times by June 30, 2013 (estimated at $12,000 to $27,000 per ophthalmologist)
  • 1.5 percent cut in 2015 for practices that didn’t meet the 2013 PQRS reporting requirement (estimated at $9,000 to $20,250 per ophthalmologist)

This cut would be on top of the 2 percent sequestration cuts implemented earlier this year, and any other cuts triggered by the sustainable growth rate.

The Academy and the American Academy of Ophthalmic Executives (AAOE) are committed to helping you protect your reimbursement. We have compiled a number of resources to help you avoid the e-prescribing and PQRS penalties for non-participation. Look for emails, reminders and other announcements and resources throughout the coming months.

E-Prescribing: Future Penalties Tied to 2013 Non-Participation
It’s not too late to avoid the penalty – even qualify for the bonus – but if you haven’t started yet, you’ll need to e-prescribe between 1.5 and 3.5 times per week between now and June 30, depending on your financial goals.

What you need to know

What to do

  • Use only the G8553 code for e-prescribing in 2013; the code must be linked to any billable service to avoid penalties. To earn the incentive, all 25 codes must be linked to an office visit. E-prescriptions during the global period do not qualify unless the prescription is given in advance during the initial exam. 
  • More information, plus implementation guidelines:

PQRS: 2013 Bonus, 2015 Penalty Tied to What You Do This Year
In 2012, ophthalmologists took home a total of $26 million in PQRS incentive payments for their participation in 2011. There are four ways to report for this year’s 0.5 percent bonus: 1) Claims, 2) electronic health record system, 3) registry, 4) cataract measure group via registry.

What you need to know about the bonus

  • Time is running out to qualify by claims for the 0.5 percent quality-reporting bonus via PQRS.
  • Successful claims reporting is defined as correctly reporting three measures 50 percent of the time.
  • You can also report through your electronic health record system or a qualified registry.
  • There are two options for registry reporting: report three measures or report 20 cataract surgical cases.

What you need to know about the penalty

  • Avoid the 1.5 percent 2015 penalty by reporting at least one exam linked to one claims-based reporting PQRS measure at least one time with dates of service between Jan. 1 and Dec. 31, 2013. Review the measure specifications to choose an appropriate measure.
  • The 2015 penalty applies to all your Medicare Part B, Medicare as a secondary payer and Railroad Medicare physician payments.

What to do

  • EHR reporting: Ensure that your system is approved to submit measures for PQRS by consulting the CMS list of approved vendors, and contact your vendor for assistance generating a measure report. Select any three of the electronic measures (meaningful use CQMs) to report. Then, simply submit your measures through your EHR vendor by Feb. 28, 2014.
  • Registry reporting: Select any three of the 15 measures available for ophthalmology to report and upload your 2013 data by Jan. 31, 2014.
  • Cataract reporting via registry: Ensure that a majority (11) of the 20 surgical cases have Medicare Part B as the primary insurance.
  • Cataract cases may be reported by Sept. 30 to ensure post-surgery surveys are completed within the global period.
  • Check Remittance Advice (RA) notices regularly to ensure receipt of remark code N365 for each PQRS measure submitted.
  • More information:

Questions? Email




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