AGA Quality Improvement Timeline
Timeline of Impact on Physician Reimbursement
There are a number of federal quality improvement programs that will affect physician reimbursement beginning in 2014. To help you meet these federal requirements, the AGA has developed a timeline to help you prepare and successfully implement the required changes. We will continue to update this timeline as new programs and deadlines arise.
Watch a webinar to learn more about the physician quality reporting system, the value-based payment modifier and the electronic health record incentive program, including how to participate in each program. View the slide presentation.
- All Programs
- Current Procedural Terminology
- AMA/Specialty Society Relative Value Update Committee
- ICD-10 Diagnosis Codes
- Meaningful Use
- Physician Quality Reporting System
- Value-Based Payment Modifier
Adopt and Demonstrate Meaningful Use
January 1, 2015
January 1, 2015
Deadline to adopt and demonstrate meaningful use of a certified electronic health record or incur an annual 1 percent decrease in Medicare payments.
2015 PQRS payment is adjusted based on VBPM
January 1, 2015
January 1, 2015
Payment is adjusted based on the value-based payment modifier (VBPM) for physicians in groups of 100+ (based on performance in 2013).
Submit claims-based reporting for the 2014 PQRS
February 2, 2015
February 27, 2015
Estimated deadline to submit claims-based reporting for the 2014 PQRS reporting period.
EPs beyond their first year must attest to meaningful use
February 28, 2014
February 28, 2015
EPs beyond their first year of meaningful use must attest to a 3-month reporting period fixed to the quarter of the calendar year to avoid 2015 and 2016 penalties.
Submit registry-based reporting for 2014 PQRS via AGA DHRP
March 1, 2015
March 31, 2015
Estimated deadline to submit registry-based reporting via AGA Digestive Health Recognition Program (DHRP).
CMS report to Congress on the Sunshine Rule
April 1, 2015
April 1, 2015
CMS report due to Congress regarding the first data reporting requirement.
CMS sends QRURs to all physicians
August 1, 2015
August 31, 2015
CMS sends Quality Use and Resource Reports (QRURs) to all physician groups and solo practitioners.
ICD-9 codes no longer accepted to report medical diagnoses and inpatient procedures.
October 1, 2015
October 1, 2015
If the transition is not complete by next fall, payors will withhold payments.
Current Procedural Terminology
Current Procedural Terminology (CPT) codes can change every year. Practices must report codes that match the description in the most current CPT book or risk losing revenue or being cited for fraudulent billing.
There are three types of CPT codes:
- Category I: five digit codes for services/procedures that are consistent with contemporary medical practice and are widely performed.
- Category II: alphanumeric codes for performance measurement (optional).
- Category III: alphanumeric codes for emerging technology.
- CPT is maintained by the AMA via the CPT Editorial Panel, which meets regularly to update the code set in order to capture new and emerging technologies and to revise the language of existing codes to reflect current medical terminology and practice.
- AGA works cooperatively with the ACG and ASGE to establish and/or revise CPT codes for new/existing procedures relevant to the practice of gastroenterology.
- AGA Coding Center
- 2014 CPT Coding Update Manual
- AGA Reference Guide: Upper GI Endoscopy Coding for 2014
- AGA Coding Frequently Asked Questions About Screening Colonoscopy
- AGA Backgrounder on the CPT Process
- AMA’s CPT Information Center
AMA/Specialty Society Relative Value Update Committee
- The RUC provides recommendations to CMS for new Current Procedural Terminology Codes® (CPT) codes and existing CPT codes that may be potentially misvalued in order to more accurately reflect current medical practice.
- The RUC makes physician work and practice expense recommendations to CMS, which the agency can use to set payments to physicians via the Medicare Physician Fee Schedule, which many private payors use as a basis for their payments.
- The RUC’s recommendations are based on data from physician surveys administered by the specialty societies about the time, intensity and complexity, and relative value of procedures.
- The RUC does not have the authority to set physician payments. It only makes recommendations to CMS on the relative value of physician work and practice expense for procedures and services. CMS may choose to accept or reject the RUC’s recommendations when it sets the rates of the Medicare Physician Fee Schedule.
- The RUC process
- "RUC Update: Mission Made Possible"
- "What is the RUC Process...and Why Should I Care?"
- The RVS Update Committee
ICD-10 Diagnosis Codes
Practices must plan now to transition to ICD-10. If the transition isn’t complete by next fall, payors will withhold payments.
ICD-10 is the new coding methodology that is replacing ICD-9.
- The current ICD-9 code set is more than 30 years old and is no longer considered usable for today’s treatment, reporting and payment processes.
- The new ICD-10 code set reflects advances in medicine and uses current medical terminology.
- The code format expands the ability to include greater detail within the code. The greater detail means that codes can provide more specific information about diagnoses.
- The transition to ICD-10 does not affect Current Procedural Terminology(R) (CPT) coding, which will still be used to report procedures in the office/outpatient settings.
- AGA Translation Guide for the Top-50 Most-Used Diagnostic Codes — one ranked alphabetically by disease state and the other ranked numerically by ICD-9-CM code (requires log in for AGA members)
- AGA ICD-10 Resource Center
- AGA GI Coding Advisor
- CMS Provider Resources
- CMS ICD-10-CM Classification Enhancements Fact Sheet
Physicians, nurse practitioners, physician assistants and hospitals can qualify for federal incentive payments when they adopt certified electronic health record (EHR) technology and “meaningfully” use it to achieve specified objectives. There’s a complex schedule of incentives and penalties for these programs — and time is running out to maximize incentives.
- Those who participate can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.
- If a provider does not adopt EHR technology and successfully demonstrate meaningful use by 2015, their Medicare reimbursement for covered professional services will be cut 1 percent each year. Hardship exceptions from the payment adjustment may be granted in certain instances.
- Meaningful Use and Electronic Medical Records for the Gastroenterology Practice
- Stage 1 Criteria for Meaningful Use
- What GI Practices Need to Know about Meaningful Use
- CMS Dedicated EHR Incentive Program Web Page
- CMS Announcement on the Delay of Meaningful Use Timeline
- ONC Resources on Meaningful Use
- CMS Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals
Physician Quality Reporting System
The Physician Quality Reporting System (PQRS) is a voluntary reporting program that provides an incentive payment and prevents penalties for providers who report data on quality measures for Medicare Part B patients.
Providers can report through claims reporting or by using a CMS-approved online platform, such as the AGA Digestive Health Recognition ProgramTM.
- For the 2013 reporting period, participating providers will receive a 0.5 percent incentive payment based on total estimated allowed charges for Medicare Part B fee for service during the reporting period and an additional .5 percent by completing a maintenance of certification (MOC) program.
- Providers who do not successfully report PQRS measures for 2013 will receive a 1.5 percent payment cut in 2015.
- Providers who do not report PQRS measures in 2014 will receive a 2 percent payment cut in 2016.
- Report PQRS measures through AGA’s Digestive Health Recognition Program
- PQRS How to Get Started
- PQRS List of Eligible Professionals
- MOC Program Incentive
Value-Based Payment Modifier
How Calculations Are Made
- Performance on outcome measures reported through PQRS will be used to calculate a quality composite score for the VBPM. Total per capita costs for Medicare beneficiaries will be used to calculate a cost composite score for the VBPM.
- CMS is gradually sending out Quality and Resource Use Reports (QRUR), which allow groups to preview value-modifier quality and cost composite scores.
- Participate in AGA's Digestive Health Recognition Program.
- Read AGA's detailed analysis of the VBPM and learn how to read your QRUR.
- Medicare Fee for Service Feedback Program/VBPM.