This blog post continues our question and answer discussion on the Value-Based Modifier program and how it will affect your practice from our recent webinar featuring Barbara J. Connors, DO, MPH, Chief Medical Officer at The Centers for Medicare & Medicaid Services Region III. You can read Questions and Answers on CMS’ Value-Based Modifier Program, Part I now.

Q: If a solo practice is MU eligible for 2014 and did not report PQRS in 2014, can it still use registry reporting in 2014 to report PQRS?

A: You still have time to participate through a Registry, although your options are limited.  See http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html for full information. The 2014 PQRS data submission window is in the first quarter of 2015; qualified registries must submit the quality measure data, in the proper format, to CMS, by March 31, 2015.

Q: Where can I find the Low/Average/High quality definitions?

A: Your best resource will be your Quality and Resource Use Reports (QRUR), which provide you with:

  • Comparative information about the quality of care furnished, and the cost of that care, to their Medicare fee-for-service (FFS) patients
  • Beneficiary-specific information to help coordinate and improve the quality and efficiency of care furnished
  • Information on how the provider group would fare under the value-based payment modifier (VBM)

You can access your QRUR at https://portal.cms.gov; follow the instructions below. (Click on images below to see full size screens.)

Value-Based Modifier QRURValue-Based Modifier QRUR

Value-Based Modifier QRUR

 

 

 

 

 

Q: For solo practitioners in primary care, what is required TO AVOID downward adjustment in 2017 – how many quality measures across how many domains?

A: To avoid the downward PQRS payment adjustment in 2017, please refer to the attached web link which describes how to select measures for 2015 PQRS: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html

Q: Will the ACO we belong to provide much of the information that will applied to our practice for PQRS, such as what we need to improve on?
A: You should have the ability to access your PQRS feedback report  through IACS.  See http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013_PQRSFeedbackReportUserGuide_F04-02-2014.pdf

Q: For 2015 forward, is claims based PQRS allowed for solo providers?
A: Yes, we understand that the claims-based reporting mechanism remains the most popular reporting mechanism. However, to streamline the PQRS reporting options, as well as to encourage reporting options with which eligible professionals are found to be more successful in reporting, it is our intention to eliminate the claims-based reporting mechanism in future rulemaking. During this time, we encourage eligible professionals to use alternative reporting methods to become familiar with reporting mechanisms other than the claims-based reporting mechanism.

Barbara J. Connors, DO, MPH, Chief Medical Officer at The Centers for Medicare & Medicaid Services Region III, has recently served as the Acting Associate Regional Administrator for the Division of Survey and Certification in CMS Northeast Consortium Regions I, II, and III.

As the Chief Medical Officer, she is responsible for ensuring the provider community is cognizant of CMS health care quality improvement initiatives, including current legislative issues that impact the provider community.

Want to learn more about the Value-Based Modifier program?

Watch our free recorded webinar, The Value-Based Modifier Program: What’s the Impact on Your Practice?

See our free infographic: What is CMS’ Value-Based Modifier Program and How Will It Affect Your Practice?

Find more information about the Value-Based Modifier program is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html

More information about the PQRS program is available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html