Prepare to Meet the Tougher Physician Quality Reporting Requirements

by | Published on Oct 10, 2014 | Healthcare News

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Physician quality reporting system (PQRS) was established in 2007 and is a pay for reporting program that provides a combination of incentive payments and negative payment adjustments to encourage providers to report quality information during patient encounters. All physicians as well as non-physician practitioners that provide covered PFS services for Medicare Part B Fee for Service (FFS) beneficiaries can participate in this program. PQRS benefits and penalty payments are calculated each year on the basis of a specified percent of each Eligible Professional (EP)’s Medicare Part B allowed charges. Here are some important facts.

  • Starting in 2015, a downward payment adjustment will apply to eligible professionals who fail to satisfactorily report data on quality measures for covered professional services or fail to satisfactorily participate in a Qualified Clinical Data Registry (QCDR).
  • CMS has proposed to add 28 new individual measures and two measures groups to fill existing measure gaps. At the same time they plan to remove 73 measures from the reporting of PQRS. With these proposed modifications, the PQRS individual measure set would become 240 total measures.
  • EPs generally have to report only nine measures covering 3 National Quality Strategy domains. CMS is now proposing that EPs who see at least one Medicare patient in a face-to-face encounter should report on at least 2 measures from a newly proposed cross-cutting measures set. This is in addition to any other measures that the EP has to report.

The deadline to submit data for 2014 PQRS is February 27, 2015.

Incentives and Penalties

An incentive equal to 0.5% of the total estimated Part B allowed charges for all covered professional services provided by the eligible professional during the applicable reporting period will be paid to EPs who satisfactorily report in the 2014 PQRS program. Group practices participating in the GPRO (Group Practice Report Option) can also qualify for PQRS incentive payments equal to 0.5% of the practice’s total estimated Medicare Part B PFS allowed charges for all covered professional services provided during a 2014 PQRS reporting period, if they meet the criteria for satisfactory reporting specified by CMS.

Non-participation in the PQRS program will bring the following penalties.

  • 2014 – No penalty
  • 2015 – -1.5%
  • 2016 – -2.0%
  • 2017 – -2.0%

Eligible professionals who do not satisfactorily report on quality measures for covered professional services during the 2014 PQRS program year will incur a 2% payment adjustment to their Medicare PFS amount for the services they provide in 2016.

Individual EPs can participate in the 2014 PQRS program via any of the following:

  • Medicare Part B Claims
  • Direct Electronic Health Records (EHR) using Certified EHR Technology (CEHRT)
  • Qualified PQRS Registry
  • Qualified clinical data registry(QCDR)
  • CEHRT via Data Submission Vendor

The 2015 QCDR measure data is proposed to be made available on Physician Compare collected either at the individual level or aggregated to a higher level of the QCDR’s choice, such as the group practice level.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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