2017-10-19 13:05:21 UTC

Tips to Avoid a 2019 Payment Penalty

Oct. 19, 2017

Report on one measure for one patient for the 2017 Quality Payment Program Performance Year.

While the deadline has passed for CMS eligible-clinicians (EC) to potentially receive a payment incentive in 2019 for the 2017 Quality Payment Program (QPP) performance year, there’s still time to avoid a penalty. By reporting one measure for one patient by Dec. 31, 2017, gastroenterologists still can avoid a 4 percent QPP payment penalty in 2019.

To avoid a 2019 QPP payment penalty, here is an example of how an EC can report on a single measure. Follow these simple steps to report Quality Measure #185 for "Colonoscopy Interval for Patients with a History of Adenomatous Polyps — Avoidance of Inappropriate Use:"

  • Complete boxes 1–20 of a CMS 1500 billing form (Health Insurance Claim Form).
  • In box 21, enter the appropriate ICD-10 diagnosis code(s) for each diagnosis and CPT or HCPCS procedure code for a patient you select (for example, for a patient receiving a colonoscopy, enter procedure code 44388, 44389, 44392, 43494, 45378, 45380, 45381, 45385, or G0105).
  • In box 24D, enter QDC code 185 for "Colonoscopy Interval for Patients with a History of Adenomatous Polyps — Avoidance of Inappropriate Use."
  • In box 24F, enter a line-item charge of $.1 for QDC 185 code entered in box 24D.
  • Complete boxes 25–33, as usual.
  • Submit the completed CMS 1500 billing form through your Medicare claims submitter.

If you prefer to submit a claim for a different measure, search for the measure you wish to report at qpp.cms.gov/measures/quality. Then, download and unzip the related specification at qpp.cms.gov/resources/education. After identifying the measure and codes you wish to submit, follow the same steps above.

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