CMS looking to recover improper payments


The Centers for Medicare and Medicaid Services (CMS) is looking to recover all the improper payments made through its Physician Quality Reporting System (PQRS) and the Electronic Prescribing Incentive (eRx) Program.

This was revealed in a notice published in the Federal Register.
Problems such as data integrity, rejected and improper payments are the main cause of this step by the CMS. It plans a four-year project to skim through its records and will look for ways to avoid such issues in the future as well.

“Data submission, processing and reporting will be analyzed for potential errors, inconsistencies and gaps that are related to data handling, program requirements, and clinical quality measure specifications,” the notice reads.

CMS plans to survey 400 group practices, registries and vendors every year and interview a select number about the programs. Since the publication of the notice, there will be a 60-day comment period that will end on May 16.

e-Prescribing has continued to grow through the federal incentive programs. In 2012, nearly 69% of physicians used e-Prescribing, with a record 788 million prescriptions (44%) routed electronically in 2012, up from 570 million (36%) in 2011. These figures were revealed by Surescripts’ annual National Progress Report and Safe e-Rx Rankings.

A New York state law creating a prescription-monitoring database has been touted as reducing doctor-shopping for painkillers by 25%. That law requires that providers e-Prescribe all drugs by March 2015.
The American College of Physicians (ACP) is calling for a similar effort nationally to help curb the growing problem of prescription drug abuse.

The Electronic Prescribing (eRx) Incentive Program is a reporting program that uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals.

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