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.

More on Colonoscopy

Important Opportunity to Advise CMS on Colonoscopy Episode

Oct. 26, 2017

It is critical that you share your feedback with CMS by Wednesday, Nov. 15.

Closing the Colonoscopy Loophole

Oct. 4, 2017

AGA committee member Shazia Mehmood Siddique’s Philadelphia Inquirer op-ed explains how current legislation is hurting patients.

Colonoscopy Cost Measure to be Tested for MIPS

Oct. 4, 2017

Prepare now to share your thoughts on the value of the measure with CMS.