Practice Fusion Webinar: PQRS in 2013 and Beyond

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The Physician Quality Reporting System (PQRS) is a Centers for Medicare and Medicaid (CMS) reporting program that uses a combination of incentive payments and payment adjustments to promote reporting …

The Physician Quality Reporting System (PQRS) is a Centers for Medicare and Medicaid (CMS) reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).

The PQRS program can be very complex, and there are more changes coming in 2014. To learn more participating in PQRS in 2013 or to understand the upcoming PQRS changes, view the slides from the Practice Fusion PQRS Webinar.

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  • Welcome to the Practice Fusion PQRS Webinar.
  • The Physician Quality Reporting System, or PQRS, is a CMS reporting program that uses a combination of incentive payments and penalties to promote reporting of quality data. Providers are eligible for participation in PQRS if they are reimbursed under the Medicare Physician Fee Schedule (PFS) and see Medicare Part B patients.This includes physicians, chiropractors, dentists, PAs, NPs, and other eligible practitioners and therapists.Under PQRS, payment incentives and penalties are determined based on eligibleprofessional services that are paid under or based on the Medicare Physician Fee Schedule.
  • Your PQRS participation in 2013 determines both your potential payment incentive and possible adjustment penalties that will effect future Medicare reimbursements.As you can see, reporting in 2013 can result in either a 0.5% payment incentive or a 1.5% payment penalty. Note that in 2014, the payment penalty increases to 2.0% of your Medicare Part B reimbursements
  • To qualify for the 2013 PQRS incentive, you must use one of the following reporting options:Claims-Based Reporting involves reporting quality data codes, or g-codes, on Medicare claims. To achieve the payment incentive, providers must report 3 individuals measures for at least 50% of Medicare patients or report 1 measures group for at least 20-patient sampleRegistry-based reporting is used when a provider registers or connects with a data registry. This means that the registry submits the data to CMS on behalf of the provider. For registry based reporting, providers must report at least 80% of eligible instances for at least three measures or report on a 20-patient sample (if reporting measures groups)The Group Practice Reporting Option, or GPRO, is available for group practices of two or more providers with a single Tax ID number. Group practices who wish to report via the GPRO web interface or GPRO registry reporting option must register with CMS prior to October 15, 2013. When submitting data to CMS for the PQRS payment incentive, keep in mind that:You will not receive credit for any measures that result in ‘0’ (zero) values in the numerator or denominatorThe 2013 PQRS program requires that all patients included for reporting must be Medicare Part B patients.Not all providers may want to put in the effort required to achieve the 2013 PQRS payment incentive. However, all providers must act in 2013 if they want to avoid the 2015 PQRS payment penalty.
  • If you want to avoid the 2015 PQRS payment penalty, you must participate in PQRS in 2013 via one of three options:Elect to be analyzed under the administrative claims-based reporting mechanism by registering with CMS prior to October 15, 2013 Report at least one applicable measure or measures group using one of the reporting options (claims reporting using quality data codes or registry reporting)Meet the criteria for the 2013 PQRS payment incentive – the requirements are only slightly more if you have already started reporting via claims, and you could be eligible for a 0.5% payment incentive.For providers who have yet to get started on PQRS, the administrative claims based reporting option is likely the best option and requires the least amount of additional effort.
  • The administrative claims-based reporting mechanism is only available for providers wishing to avoid the 2015 PQRS payment penalty and does not require the eligible professional to submit QDCs on Medicare Part B claims. However, because CMS, rather than the eligible professional, is collecting the data and performing the analysis on Medicare claims for the eligible professional’s Medicare beneficiaries, the requirements are slightly different.The only action requirement by providers wishing to participate in PQRS via the administrative claims-based reporting mechanism is that the provider submit Medicare claims to CMS during the reporting year.CMS will do analysis on your Medicare Part B claims to determine that you can avoid the 2015 PQRS payment penalty.Providers who choose the administrative claims-based reporting mechanism will be evaluated on 19 quality measures for 100% of their applicable Medicare Part B Fee-for-Service beneficiaries for whom the measure applies.
  • To register for the CMS administrative claims-based reporting option before October 15, 2013You must first register for a CMS-IACS account if you do not already have one, or add the appropriate IACS role if you have an existing account. After that, visit the CMS Enterprise Portal and register for the PV-PQRS option near the bottom of the page after you login in with your IACS credentials. If you need assistance with the registration process, contact the CMS QualityNet Help Desk using the contact information listed on the slide. PQRS participation in 2013 has many options, but there are even more changes coming to PQRS in 2014, especially for Practice Fusion providers.
  • Beginning in 2014, Practice Fusion providers will have more reporting options available for meeting the requirements for the 2014 PQRS payment incentive:In addition to the three options that are available in 2013, providers will also be able to reporting measures directly to CMS via their EHRPractice Fusion will support a set number of CMS certified quality measures that will be available for PQRS reportingThe list of quality measures that will be available in 2014 will be released before the end of 2013. Reporting changes are just part of what’s new in 2014 for PQRS. There are also additional program changes that effect providers who are also participating in Meaningful Use.
  • In 2014, providers participating in the CMS EHR Incentive Program will also have the option of meeting the Meaningful Use program Clinical Quality Measure (CQM) reporting requirements by successfully participating in PQRS.This option is available to providers who will be in Stage 1 or Stage 2 in 2014.CQMs will be submitted by Practice Fusion prior to February 28, 2015 for the full 2014 calendar year.Providers will still use a 3-month reporting period for the MU program Core and Menu measures.Note that providers who will be in their first year of the Meaningful Use program in 2014 will not be able to use the PQRS option for meeting the CQM requirements, because they will need to report CQM values to CMS during attestation prior to October 1, 2014 in order to avoid the 2015 Meaningful Use payment penalty. Providers in their first year of MU can still report CQMs for PQRS via the EHR e-submission method, but it will not count towards MU requirements.
  • We will now answer some questions submitted by you all during the course of the presentation.
  • If you would like to report via a registry, a list of CMS-approved PQRS registries is available on the CMS PQRS website under Registry Reporting.
  • If you would like to report via a registry, a list of CMS-approved PQRS registries is available on the CMS PQRS website under Registry Reporting.
  • We are nearing the end of our webinar session. On the screen now is a brief list of PQRS resources that may be helpful for providers who want to know more about PQRS participation. For links to these resources and more information, please visit the Practice Fusion PQRS blog post. A link will be sent to all webinar participants following today’s presentation.Thank you all for joining!

Transcript

  • 1. PQRS REPORTING IN 2013 Fulfilling requirements in 2013 and a look to the future of PQRS By: Emily Richmond, Senior Manager Health Care Quality, Practice Fusion, Inc. The materials in this presentation, or prepared as part of this presentation, are provided for informational purposes only and do not constitute legal advice or legal opinions. You should not act or rely on any information contained in this presentation, or any materials prepared for this presentation, without first seeking the advice of a qualified and independent attorney.
  • 2. What is the Physician Quality Reporting System? PQRS is a CMS reporting program that uses a combination of incentive payments and penalties to promote reporting of quality data Who is eligible for PQRS? + Providers who see Medicare Part B patients and are reimbursed under the Medicare Physician Fee Schedule (PFS). + This includes physicians, chiropractors, dentists, PAs, NPs, and other eligible practitioners and therapists. What services are PQRS eligible? + Under PQRS, covered professional services are those paid under or based on the Medicare PFS. + Those services are eligible for PQRS incentive payments and/or payment adjustments.
  • 3. PQRS Participation in 2013 Your PQRS participation in 2013 determines both your potential payment incentive and possible adjustment penalties that will effect future Medicare reimbursements: Year Incentive Payment 2013 2014 Payment Adjustment 2015 2016 2017+ Year Data Collected to Inform Payment/Penalty Bonus/Adjustment 2013 2014 +0.5% +0.5% 2013 2014 2015 -1.5% -2.0% -2.0%
  • 4. How to Get the 2013 PQRS Payment Incentive To qualify for the 2013 PQRS incentive, you must use one of the following reporting options: Claims-Based Registry-Based GPRO • Submit Quality Data Codes (GCodes) via claims • Report 3 individuals measures for at least 50% of Medicare patients • Report 1 measures group for at least 20-patient sample • Provider submits data to registry, who submits data to CMS • Report at least 80% of eligible instances for at least three measures • Report on a 20patient sample (if reporting measures groups) • The Group Practice Reporting Option is available to group practices of 2 or more providers under a single Tax ID Number • Registration with CMS is required and data is reported via registry or web interface
  • 5. Avoiding the 2015 PQRS Payment Penalty If you want to avoid the 2015 PQRS payment penalty, you must participate in PQRS in 2013 via one of these three options: Meet the 2013 PQRS Payment Incentive Requirements • More requirements, but you are eligible for a 0.5% payment incentive! Report 1 measure • Report for at least one eligible or patient, via claims (using QDCs) or measures group via a registry Administrative Claims-Based Reporting • To use this method, you must register with CMS prior to October 15, 2013
  • 6. Administrative Claims-Based Reporting Method The administrative claims-based reporting mechanism does not require the eligible professional to submit QDCs on Medicare Part B claims. + CMS will do analysis on your claims to determine that you can avoid the 2015 PQRS payment penalty. + Providers who choose the administrative claims-based reporting mechanism will be evaluated on 19 quality measures for 100% of their applicable Medicare Part B Fee-for-Service beneficiaries for whom the measure applies. Providers do not need to do any additional work in Practice Fusion for the administrative claims reporting method – simply submit Medicare Claims as usual and register via CMS.
  • 7. Registering with CMS Registering with CMS by October 15, 2013 is only required for providers who wish to using the administrative claims-based reporting mechanism in 2013. + To register for the CMS administrative claims-based reporting option follow the steps below: 1. Register for an Individuals Authorized Access to the CMS Computer Services (CMS-IACS) account if you do not already have one, or add the appropriate IACS role if you have an existing account. 2. Visit the CMS Enterprise Portal and register for the PV-PQRS option near the bottom of the page after you login in with your IACS credentials. For IACS and CMS registration support, contact the QualityNet Help Desk at 866-288-8912 or via email at qnetsupport@sdps.org
  • 8. What’s to come? PQRS in 2014 Beginning in 2014, providers will have additional reporting options available for meeting the requirements for the 2014 PQRS payment incentive: ClaimsBased Reporting EHR eReporting RegistryBased Reporting GPRO Reporting
  • 9. Using PQRS to Meet MU Requirements in 2014 In 2014, providers participating in the CMS EHR Incentive Program will also have the option of meeting the Meaningful Use program Clinical Quality Measure (CQM) reporting requirements by successfully participating in PQRS. + This option is available to providers who will be in Stage 1 or Stage 2 in 2014. + CQMs will be submitted by Practice Fusion prior to February 28, 2015 for the full 2014 calendar year. + Providers will still use a 3-month reporting period for the MU program Core and Menu measures.
  • 10. Frequently Asked Questions How do I find out if I am eligible for PQRS? A. Most health care providers who are reimbursed under the Medicare Physician Fee Schedule are eligible for PQRS. For additional details and a list of eligible PQRS providers go to: http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment- Instruments/PQRS/How_To_Get_Started.html
  • 11. Frequently Asked Questions I reported G-codes on my e-prescriptions earlier this year, will that be enough to meet PQRS requirements? A. The CMS eRx Incentive Program also uses G-codes, which are submitted via e-prescriptions. The G8553 code submitted for the eRx incentive program cannot be used to meet PQRS requirements. PQRS has unique G-codes for each measure, so you must use the applicable codes and submit them on Medicare claims.
  • 12. Frequently Asked Questions What reporting option should I use to simply avoid the penalty this year with the least amount of effort? A. The Administrative Claims Based reporting option is likely the best option and requires only that you register with CMS and continue to submit Medicare claims as usual. There is no additional work required in your EHR. Another option is to report an applicable G-code on a Medicare claim for one measure for one patient who meets the measure requirements.
  • 13. Frequently Asked Questions I am already reporting with G-codes on my billing for PQRS or reporting thru a registry. Do I still need to register with CMS? A. Registration with CMS by October 15, 2013 is only necessary for providers who wish to avoid the 2015 PQRS Payment Penalty by reporting via the administrative claims-based reporting mechanism or for group practices wishing to self-nominate to report for PQRS under the GPRO.
  • 14. Frequently Asked Questions I want to report Quality Data Codes via Medicare claims in order to earn the PQRS Payment Incentive. Is it too late to get started now? A. Providers wishing to meet the PQRS payment incentive requirements via the claims-based reporting method must submit QDCs for at least 50% of their Medicare patients for at least 3 individual measures or a 20-patient sample for reporting 1 measures group. With only a couple months left in 2013, it may be difficult to meet the payment incentive requirements, but since one of the methods for avoiding the penalty also uses G-codes, your efforts will go towards that as well.
  • 15. Additional PQRS Resources For information on PQRS eligibility, go to http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/How_To_Get_Started.html For more information on the 2015 PQRS payment adjustment, go to http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Payment-Adjustment-Information.html Still have questions? Email PQRS@PracticeFusion.com