Health Policy News

    There is Still Time to Avoid the 2015 PQRS Payment Adjustment!

    If you are considered eligible and able to participate in the Physician Quality Reporting System (PQRS), you may be subject to payment adjustments beginning in 2015.

    Eligible professionals (EPs) and group practices that fail to satisfactorily report data on quality measures during the 2013 program year will be subject to a 1.5% payment adjustment of their Physician Fee Schedule (PFS) charges beginning in 2015.

    If you and/or your group practice are not planning to meet the requirements to earn an incentive for satisfactorily reporting in 2013, and did not elect the administrative claims-based reporting option, you can still avoid the adjustment by doing the following:

    Individual EPs
    EPs can avoid the 2015 payment adjustment if they report at least:

    • One valid measure via claims, participating registry, or through a qualified Electronic Health Record (EHR) OR
    • One valid measures group via claims or participating registry

    Group Practices
    Group practices participating in the GPRO can avoid 2015 payment adjustments if they report at least:

    Report By December 31
    These criteria must be met during the 2013 PQRS program year, January 1-December 31, 2013. Take action by December 31 to avoid the 2015 payment adjustment!

    View the PQRS Payment Adjustments Tip Sheet for more information on how to avoid the 2015 payment adjustment.

    For more information or support on the PQRS program, please visit the PQRS Incentive Program website.

    FPMRS Taxonomy Code

    If you passed the FPMRS Board Exam, Update your Medicare Enrollment and Private Insurance Contract Information to reflect this Specialization.

    Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers. The Code Set is maintained by the National Uniform Claim Committee.  The Code Set is a Health Insurance Portability and Accountability (HIPAA) standard code set.  As such, it is the only code set that may be used in HIPAA standard transactions to report the type/classification/specialization of a health care provider when such reporting is required.

    Why is it important to update your Healthcare Provider Taxonomy Code?

    As the Centers for Medicare and Medicaid Services (CMS) continues to implement the Value-Based Payment Modifier for physicians, physicians’ quality and cost, “scores,” will be compared to their peers.  One way for the Medicare program to define peers could be by using taxonomy codes.  Also, in the House Energy and Commerce Committee proposed legislation to repeal the sustainable growth rate (SGR), the proposed new payment system would be based on quality scores for physicians by cohort, with the cohort defined by ABMS approved specialties.  A way to segment by ABMS approved specialties is to use taxonomy codes.

    Taxonomy Code for Female Pelvic Medicine and Reconstructive Surgery

    Effective January 1, 2012, the National Uniform Claim Committee at the request of the American Board of Medical Specialties created a new healthcare provider taxonomy code to recognize the subspecialty of Female Pelvic Medicine and Reconstructive Surgery.

    Taxonomy Code 207VF0040X                    Female Pelvic Medicine and Reconstructive Surgery       

    A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.

    When health care providers apply for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES), a health care provider must select the Healthcare Provider Taxonomy Code or code description that the health care provider determines most closely describes the health care provider's type/classification/specialization, and report that code or code description in the NPI application.  If you passed the FPMRS Board exam, you can now amend your information with Medicare through their on-line system to reflect your new level of specialization. You may want to call those private insurance companies that you are on contract with to amend your contract to reflect this taxonomy code, as well.

    For Medicare, the Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used to update your enrollment information. Please visit the page of the Centers for Medicare and Medicaid Services (CMS) web site for the Internet-based PECOS system where there is a tutorial regarding how to use this system to update your Medicare provider and National Provider Identifier (NPI) information.

    Click here to view additonal practice management resources from AUGS.   

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