Incentive Programs - JF Part B

Several incentive programs are available for providers.

Electronic Health Records (EHR) - Electronic version of a patient's medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

Electronic Prescribing (eRx) - Uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals.

Health Professional Shortage Area (HPSA) and HPSA Surgical Incentive Payment (HSIP) - HPSAs are geographic areas, or populations within geographic areas, that lack sufficient health care providers to meet the health care needs of the area or population. HPSAs identify areas of greater need throughout the United States (U.S.) so that limited resources can go to those areas. The Health Resources and Services Administration (HRSA) designates areas as HPSAs based on census tracts, townships, or counties. Designations are made for primary care, dental, and mental health.

HSIP was developed to improve Medicare beneficiary access to major surgical procedures. Incentives are for physicians enrolled as general surgeons when providing surgical procedures defined by a 10 day or 90 day global period. The HSIP incentive applies to services furnished on or after January 1, 2011 and before January 1, 2016.

Merit-Based Incentive Payment System (MIPS) and Advance Alternative Payment Model (APM) - CMS has contracted with the Physician Value Help Desk, Million Hearts, to conduct education and answer inquiries regarding MIPS and the Quality Payment Program (QPP). Noridian is providing basic information, resources and related hyperlinks to help redirect providers to the proper entities administering the programs.

Primary Care Incentive Program (PCIP) - Will allow physicians in primary care practices a 10% bonus regardless of which zip code they practice in. The 10% will be paid quarterly and will be based on the actual amount paid, not the allowed amount. If the EP practices in a HPSA area they will qualify for both the PCIP and HPSA bonus payments. The PCIP incentive applies to services furnished on or after January 1, 2011 and before January 1.

Physician Quality Reporting System (PQRS) - Uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs)

Value Based Modifier (VBM) - This program evaluates the quality and cost of care provided to Medicare beneficiaries and provides differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule and was created with the goal of improving the quality and efficiency of medical care.