Participation in the Physician Quality Reporting System, formerly known as PQRI, does not have to be complicated or require complex coding systems and expensive manual processes. TMA endorses two online tools for PQRS: PQRIwizard, and Covisint DocSite. Each provides a simple and cost-effective way for eligible physicians to collect and report quality measures data under the PQRS pay-for-reporting program.
PQRIwizard and DocSite will each guide you through four easy steps: (1) select your measures, (2) register, (3) enter clinical data for 30 unique Medicare Part B patients, and (4) review and submit using the online application. Eligible physicians can earn an additional 1 percent of total estimated Medicare Part B allowed charges for the reporting year.
PQRIwizard and DocSite are easy to use for small practices and competitively priced with TMA’s discounted rate: $199 for PQRIwizard, and $195 for DocSite. (Returning DocSite users can call the TMA Knowledge Center at (800) 880-7955 to arrange for an addtitional discount). The tools enable you to participate in the PQRS program without modifying your billing processes. On average, 2009 bonus payments for satisfactory reporters in the Physician Quality Reporting System were $1,956 per eligible professional.
PQRS is a voluntary reporting program that pays bonuses to physicians and other eligible health care professionals who satisfactorily report data on quality measures in treating Medicare Part B patients. The program's intent is to get physicians used to documenting and reporting the care they already provide to patients.
In 2007 and 2008, the bonus equaled 1.5 percent of a physician's total allowed charges for Physician Fee Schedule services. That increased to 2 percent in 2009 and 2010. Under the Affordable Care Act, however, the bonuses dropped to 1 percent for 2011 and 0.5 percent for 2012 through 2014.
In 2015, physicians who do not report data to PQRS will see a 1.5-percent cut in their payments. That penalty increases to 2 percent in 2016 and subsequent years.
Based on Section 10331 of the Affordable Care Act, CMS plans to make information on physician performance public on the Physician Compare Web Site. This will include measures collected under PQRS.
Several physicians have notified TMA that CMS has posted incomplete and/or inaccurate information on its website. We were concerned about this issue prior to implementation and made CMS aware of our concerns. “In order to ensure accuracy,” the association wrote, “TMA recommends CMS establish a process by which an individual physician or physicians in a group practice can review and update their demographic information directly through the website.” Additionally, we believe that physicians involved in the treatment of a patient must have the opportunity for review, comment, and the right to appeal any data that is part of the public review process, prior to posting such information on the site. Any such comments resulting from the review and appeal process must be included with any publicly reported data.
Should they find any errors, TMA recommends that physicians contact the CMS QualityNet Help Desk at (866) 288-8912 to update their information.
TMA encourages those physicians who have adopted EHRs to check with their vendor to see if their system is capable of reporting their PQRS data to CMS. This route minimizes practice resources as it is often a free service and does not require staff time to review charts and to re-enter patient information.
TMA recommends physicians who have not adopted EHRs to use a registry to report to CMS. Qualified registries have undergone a CMS vetting process that includes checking their ability to provide the required PQRS data elements, ensuring that the registry calculates the measure's reporting and performance rates correctly, and transmitting the required information in the requested file format. Reporting via registry has proven to be more successful than via claims. It simplifies the process and allows the doctor to report on just the required 30 patients rather than having to remember to include the special quality code on every claim they submit.
Some physicians don't take advantage of PQRS and e-prescribing because they either don't know about them or believe they will be too much work, says Houston family physician David Auer, MD. "It sounds like it's going to be a hassle, but it's really amazingly simple," he said.
Dr. Auer, a solo practitioner, has participated in PQRS for three years. He twice reported on preventive care measures and once on diabetes measures. Dr. Auer says reporting on the preventive care measures was very easy to do. It was a matter of spending a few minutes each with 30 patients to determine whether they were current on such preventive services as colonoscopies or mammograms, then entering the data into a registry.
Visit www.cms.gov/PQRI for more information.
If this is not the case, we recognize that all practices and their patient mixes are different, and would recommend physicians contact their specialty medical society for the most relevant measures and/or measure groups on which they can report.
Contact your medical specialty society to see if you are eligible for this year's PQRS MOC bonus.
CMS help desk resources:
External User Services (EUS) – 7 am – 7 pm, ETPhone: (866) 484-8049TTY: (866) 523-4759Email: EUSsupport@cgi.com
This service will help you in:
QualityNet Help Desk:
7 am – 7 pm, CTPhone: (866) 288-8912Email: Qnetsupport@sdps.org
Practices also may use a "quality reporting portal" to confirm whether a feedback report exists for their Tax Identification Number (TIN) or a National Provider Identifier (NPI). If a report exists, there are two ways to access it.
1. Individual eligible professionals may call their local Medicare contractor and request that the contractor e-mail the report based on the individual NPI. Individual physicians in a group practice may individually use this option. For further information on this process, see CMS MLN educational article SE0922.
2. Group practices that want to access feedback reports at the TIN level must once again use the quality reporting portal, which also requires a user ID and password to the Individuals Authorized Access to CMS Computer Services (IACS) system. Use the CMS IACS account management page to verify access to your IACS account.
CMS recently posted several resources to help PQRS participants review feedback reports, as well as prepare practices that are considering participation in PQRS.
Visit www.cms.gov/PQRI for the most up-to-date information.
The American Medical Association has participation tools on its website to help physicians who want to take part in PQRS. Tools for each of the individual quality measures and measures groups that can be reported through claims-based submission are available.
TMA recommends that physicians report to CMS via a qualified registry as those physicians have traditionally been more successful in reporting their clinical data.
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