PQRS has changed in 2014, so here are some things you should know about this quality program:
1. November 1, 2014 – EPs who participated in the 2013 PQRS program can begin requesting an informal review of their 2013 PQRS results
2. December 31, 2014 – Reporting for the 2014 PQRS program year ends for both group practices and individuals (Note: 2014 program year data will determine the 2014 PQRS incentive payment and the 2016 payment adjustment)
3. For the EHR reporting method you will need an EHR that is Meaningful Use Stage 2 Certified, certified to the June 2013 version of the eCQMs (electronic Clinical Quality Measures), and can create a QRDA file with your data at the end of the year. Not all EHRs meet these qualifications, so be sure to check.
4. Eligible professionals can avoid the 2016 payment adjustment by meeting one of the following criteria during the 2014 PQRS program year:
A. The simplest way is to use the same Meaningful Use 2014 file for PQRS reporting
- Follow the same CQM rules as Meaningful Use – but make sure each measure has a numerator of 1 and at least one Fee for Service Medicare Patient
B. Report at least 3 measures covering one NQS domain for at least 50 percent of the eligible professional’s Medicare Part B FFS patients via claims or qualified registry
- An eligible professional that reports fewer than 3 measures covering at least 1 NQS domain via claims or qualified registry- reporting will be subject to the Measure-Applicability Validation (MAV) process, which will allow CMS to determine whether additional measures domains should have been reported.
5. Submission of EHR data must be completed in the first quarter following the reporting year.
6. Many specialists have been concerned that they may not be able to find enough measures that were applicable for them. If you are having trouble, the best thing to do is to check with your specialty society. Here are some additional resources you can use:
Physical Medicine & Rehab
7. What if you can’t find enough measures that are appropriate for your specialty?
- If you report on fewer than nine measures and three domains, CMS will perform a measure-applicability validation (MAV) to verify that no additional measures/domains were applicable to you.
- As long as the MAV confirms that you reported on all applicable measures and domains, you’ll still be eligible for an incentive.
- If the MAV finds you should have reported on additional measures and/or measures covering additional domains, you’ll be subject to the 2016 payment adjustment.
8. Impact of Not Reporting for PQRS
What if you decide not to report for PQRS? You might be willing to give up the incentive payment of just .5%, but you should think long and hard about the effect of the 2% penalty and public reporting of your failure to participate, as this can impact your revenue in years to come.
- Currently Physician Compare identifies individuals and group practices that have satisfactorily reported under PQRS, e-prescribing, or Medicare EHR incentive programs.
- In 2015, CMS will publicly report 2014 PQRS performance data for individual physicians and/or physician groups for all claims, EHR, or registry reported measures.
- CMS will provide a 30-day preview period prior to any publication of any quality data
With a 2014 Meaningful Use certified EHR such as MediTouch that simplifies PQRS reporting with specially-developed tools, you can meet these requirements fairly painlessly. But if you haven’t started, don’t delay any longer.