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 qualified registries or online tools for PQRS: PQRSwizard,
and Covisint PQRS. Each provides a simple and cost-effective way for eligible physicians to collect and report quality measures data under the PQRS
PQRSwizard and Covisint PQRS will each guide you
through four easy steps: (1) select your measures, (2) register, (3) enter clinical data for 20 patients for measures group reporting (11 of which must be Medicare Part B patients) or 50 percent of eligible instances of your Medicare Part B patients for individual measures reporting, and (4) review and submit
using the online application. Eligible physicians can earn an additional 0.5 percent of total estimated Medicare Part B allowed charges for the reporting
PQRSwizard and Covisint PQRS are easy to use and competitively priced with TMA’s discounted rate: $199 for PQRSwizard,
and $195 for Covisint PQRS (use
discount code TMAPQRS14). The tools enable you to participate
in the PQRS program without modifying your billing processes.
TMA members also receive exclusive pricing for the on-demand webinar 2014 Physician Quality Reporting System (PQRS), now available in the TMA Education Center.
Find more on PQRS from the Centers for Medicare & Medicaid Services (CMS).
TMA has developed tools to assist you. Please see the menu to the left for available resources on clinical effectiveness, patient experience, performance improvement programs, and related topics.
PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality data by physicians and other eligible health care professionals that provide care to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). 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.
Physicians who do not report quality data to CMS for the 2014 PQRS program year will see a negative 2-percent payment adjustment in 2016. Click here to learn more about the PQRS payment adjustment.
Beginning in 2015, physicians deemed eligible professionals (EPs) who did not report or satisfactorily participate in PQRS in 2013 will be paid 1.5 percent less than the Medicare Physician Fee Schedule (MPFS) amount for services. Physicians in group practices with 100 or more EPs will be subject to an additional 1 percent pay cut under the value modifier program in 2015, based on their quality and cost performance in 2013. The value modifier is based on participation in PQRS. These payment adjustments will apply to all Part B covered professional services under the MPFS.
Physicians can avoid the payment adjustments in 2016 by reporting PQRS data in 2014. Failure to report in 2014 will result in a 2-percent payment adjustment in 2016 under PQRS for all physicians, plus another 2 percent payment adjustment under the value modifier for group practices with 10 or more EPs. Refer to this graph to see how PQRS participation affects the value modifier.
ALL physicians who participate in fee-for-service Medicare will be subject to the value modifier in 2017.
Click here to learn more about the value modifier.
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.
The first step in getting started with PQRS is to determine eligibility. Click here to see a list of eligible professionals (EPs).
Physicians may participate in PQRS as Individual EPs, as a group practice reporting as Individual EPs, or as a group practice under the Group Practice Reporting Option (GPRO). Group practices that plan on reporting under GPRO must self-nominate/register by September 30, 2014. Click here to learn why a group practice may want to or should register under GPRO.
PQRS reporting methods vary and reporting can be done via claims (CMS-1500 form), qualified registry, direct electronic health records (EHRs) using Certified EHR Technology (CEHRT), CEHRT via data submission vendor, qualified clinical data registry (QCDR), web interface, and CG CAHPS CMS-certified survey vendor.
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. 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. Read more about the benefits of registry reporting in the November 2014 issue of Texas Medicine.
Reporting via registry has proven to be more successful than via claims. However, if physicians prefer to report via claims, the American Medical Association has a participation tool on its website to help physicians successfully report on individual measures via the claims-based reporting method. Click here to learn more about AMA’s participation tool.
Click here for more information on how to get started with PQRS.
When selecting measures, eligible professionals (EP) should begin with a review of the 2014 Physician Quality Reporting System (PQRS) Measures List to determine which measures, associated domains, and reporting option(s) are applicable to the EP or group practice for the 2014 PQRS program year.
Before selecting measures, EPs should consider the following factors: • Clinical conditions usually treated• Types of care typically provided• Settings where care is usually delivered • Quality improvement goals for 2014• Other quality reporting programs in use or being consideredIn 2014, most PQRS reporting options require an EP or group practice to report 9 or more measures covering at least 3 National Quality Strategy (NQS) domains for incentive purposes. The domains associated with the measures are as follows:• Patient Safety• Person and Caregiver-Centered Experience and Outcomes• Communication and Care Coordination• Effective Clinical Care• Community/Population Health• Efficiency and Cost Reduction
All practices and their patient mixes are different, and TMA recommends physicians contact their specialty medical society for the most relevant individual measures and/or measure groups on which they can report.
Click here to learn more about PQRS measures.
Contact your medical specialty society to see if you are eligible for this year's PQRS MOC bonus.
Click here to learn more about the PQRS MOC Program Incentive.
Submission Deadlines for the 2014 PQRS Program Year
PQRS Feedback ReportsFor information on PQRS feedback reports and step-by-step guidance on how to request one, click here.For technical assistance, contact the CMS QualityNet Help Desk:Monday - Friday: 7 am - 7 pm, CTPhone: (866) 288-8912 (TTY 1-877-715-6222)Email: Qnetsupport@hcqis.org
Quality and Resource Use Reports (QRURs)The Value-Based Payment Modifier is based on PQRS data and cost performance. For information on QRURs and step-by-step guidance on how to request one, click here. For questions related to an IACS account and accessing your QRUR, contact the CMS Quality Net Help Desk.For technical assistance about information in your QRUR, contact the CMS Physician Value Help Desk:Monday – Friday: 7 am – 7 pm, CTPhone: (888) 734-6433, press option 3; (TTY 1-888-734-6563)
TMF Health Quality Institute is under contract with Medicare to serve as the state's Quality Innovation Network Quality Improvement Organization (QIN-QIO). Medicare funds the TMF QIN-QIO to help solo physicians and group practices with their quality reporting to advance quality improvement efforts in programs such as PQRS, Value-Based Payment Modifier, and meaningful use at no cost to physicians.
Read more about TMF's contract and how the institute can help you in the October 2014 issue of Texas Medicine. Or, contact one of the TMF QIN-QIO representatives for information:
Christine AllenProgram Managerchris.firstname.lastname@example.org(866) 439-8863
Tracy SwobodaProject Resource Consultanttracy.email@example.com (361) 258-1053
CMS is the authoritative source for PQRS information and has educational modules and various resources available to assist physicians with PQRS participation. Visit www.cms.gov/PQRS for the most up-to-date information.
CMS PQRS Training Modules:Quality Measurement 1012014 PQRS Reporting RequirementsHow to Report Once for 2014 Medicare Quality Reporting Programs
Refer to these portions of the TMA website:
Deadlines for Doctors Continuing Medical Education on Quality Improvement TopicsHITTMA Practice ConsultingPayment AdvocacyCancer Control and Prevention
Or Contact the TMA Knowledge Center:(800) firstname.lastname@example.orgAsk TMA
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