Learn About 2014 Physician Fee Schedule Rule Changes Affecting eHealth Programs Next Year

CMS recently issued a final rule that updates the payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2014. The changes affect programs such as the Physician Quality Reporting System (PQRS), the EHR Incentive Programs, and the Value-Based Payment Modifier (Value Modifier) payment model. Many of these changes make participating in multiple eHealth programs easier.

Here are some helpful highlights:


Providers can no longer avoid the 2016 payment adjustment by selecting the administrative claims-based reporting mechanism next year. Instead, providers must report using the program set of clinical quality measures.

There are also several new PQRS reporting options for 2014, including:

  • Certified survey vendor reporting (CAHPS) mechanism and EHR reporting for groups
  • Qualified clinical quality registry (QCDR) for individual eligible professionals

Value-Based Payment Modifier

The group size threshold for the value modifier has been lowered. Starting in 2016, groups of physicians with 10 or more eligible professionals are subject to the value-based payment modifier.

EHR Incentive Program

Next year, Medicare eligible professionals can submit clinical quality measurement (CQM) information using QCDRs (as defined for PQRS) to meet the CQM reporting component of meaningful use.

Of note: Medicare eligible professionals will have to use 2014 certified EHR technology (CEHRT) and report on 2014 CQMs.

Comprehensive Primary Care Initiative (CPCI)

Beginning in calendar year (CY) 2014, eligible professionals in a CPCI practice that successfully submit at least 9 CQMs covering 3 domains can choose a group reporting option for the Medicare EHR Incentive Program.

Eligible professionals in a CPCI practice site will satisfy the CQM reporting component of meaningful use if the practice site successfully submits and meets the reporting requirements of the CPCI.

Accountable Care Organizations

To align with PQRS next year, Medicare Shared Savings ACOs will report the ACO group practice reporting option (GPRO) measures through a CMS web interface on behalf of eligible professionals.

ACOs must also meet the criteria for the 2014 PQRS incentive to satisfactorily report and avoid the 2016 PQRS payment adjustment.

Learn More

Read the CMS press release to learn more about the 2014 PFS rule. To learn more about eHealth, visit www.cms.gov/ehealth.

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