Avoid the PQRS Penalty


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Updated With a Second Option!

For practices not currently participating in the Medicare Physician Quality Reporting System, and who don’t want to use a qualified registry or electronic health record PQRS reporting mechanism, another Medicare penalty is looming. Take action now to sign up for a temporary mechanism to prevent it.

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Avoid the PQRS Penalty

  1. 1. How to Avoid the PQRS Penalty
  2. 2. Quick Action Will Avoid a Penalty  For practices not currently participating in the Medicare Physician Quality Reporting System, another Medicare penalty is looming. Take action now to sign up for a temporary mechanism to prevent it.  Practices that don't participate in PQRS have until Oct. 15 to ensure they don't get a 1.5% penalty on all Medicare claims in 2015. The Centers for Medicare & Medicaid Services (CMS) has created two options to avoid the penalty.
  3. 3. The Skinny  Practices not participating in PQRS in 2013 will pay a 1.5-percent penalty on their Medicare claims in 2015. The Centers for Medicare & Medicaid Services (CMS) has created two options that allow physicians and group practices to still participate in PQRS in 2013 and avoid the penalty — but not be eligible for the PRQS incentive.  These two options are for 2013 only.
  4. 4. 1. Administrative Claims-Based Option  To use this option, you must sign up by Oct. 15, 2013. Under this method, physicians or groups can participate in PQRS and avoid the penalty just by signing up — no quality reporting required.  But don’t delay. Signing up is a multistep process, and practices have reported significant delays in getting their sign-up approved and completed through the Medicare system.  (Skip to summary of the second option)
  5. 5. Step 1  Get a new IACS (Individuals Authorized Access to the CMS Computer Services) account or modify an existing account as soon as possible at https://applications.cms.hhs.gov. Individual physicians are identified in IACS by their taxpayer identification number (TIN) and National Provider Identifier (NPI). Groups (two or more eligible professionals) are identified by their TIN. Individuals who bill under the group's TIN do not have to get an IACS account or register for PQRS individually.  If you/your group already has an active IACS account: You must add a PV- PQRS Registration System "role" (i.e., designate a person as PQRS representative) to the account. (CMS quick-reference guide for individual physicians and quick-reference guide for group practices.)  If you/your group is creating a new account: You must designate one person to be the IACS account representative and request approval from CMS. This is where the delay is occurring. Once this role is approved, the representative can designate the PQRS representative within IACS (can be the same person). CMS quick-reference guide
  6. 6. Step 2  Register in the PV-PQRS Registration System at https://portal.cms.gov using your IACS user ID and password.
  7. 7. Step 3  Choose as your reporting mechanism the administrative claims-based reporting option. Under this temporary reporting mechanism, CMS will automatically analyze all your Medicare claims to find out if you performed a designated set of clinical quality actions (see Tables 123 and 124) over the reporting year. A zero performance rate in any of these actions will not count against you. By signing up for this reporting option so that Medicare can analyze your data, you will not be penalized in 2015 for not participating in PQRS in 2013.  Under the administrative claims-based reporting option, you do not have to submit specific quality data codes for PQRS measures, like you do with traditional PQRS reporting via registry, EHR, or claims.  You will not earn PQRS incentives for reporting through this option; you will only avoid the future penalty.
  8. 8. 2. Option to Report One Individual Measure or Measure Group  This option requires only that the physician or group practice report for 2013 on one measure for one applicable patient. (Individual physicians only may report on one measures group for at least one applicable patient.)  Individual physicians may report via claims, registry, or qualified electronic health record (EHR). Group practice may report using a qualified registry or the group practice reporting option Web interface.  See CMS’ 2015 PQRS Payment Adjustment tip sheet for information about using this method to avoid the 2015 penalty.
  9. 9. Additional Options Physicians and groups can still fully participate in PQRS for 2013 and earn incentive payments, as well as avoid the penalty, by reporting the required measures via claims, registry, or certified EHR. Visit www.cms.gov/PQRI for complete details. For claims-based reporting, all claims adjustments, reopenings, or appeals processed by Novitas Solutions must reach the national Medicare claims system data warehouse by Feb. 28, 2014, to be included in the 2013 PQRS analysis. The submission deadline for the PQRS wizard registry is March 13, 2014. For Covisint PQRS, the submission deadline is March 1, 2014. Learn about TMA's discounted rates for these registries.
  10. 10. Additional Options  You have until Feb. 28, 2014, to submit data via a qualified EHR PQRS reporting mechanism. Find out from your EHR vendor if this capability is incorporated into your EHR or is an add-on service.  Group practices of 100 or more eligible professionals also can elect to be subject to a value-based payment modifier under a quality- tiering calculation.
  11. 11. More Information  Find out more about signing up for the CMS-calculated claims option.  Detailed instructions from CMS about registering on IACS and the PV- PQRS Registration System. Or call the CMS QualityNet Help Desk at (866) 288-8912, 7 am- 7 pm CT, or email gnetsuppor@sdps.org. Expect long wait times.  Listen to a short podcast about PQRS 2013 dates from the American College of Physicians.  CMS’ PQRS decision tree helps practices choose reporting via claims (page 1), registry (page 2), or EHR (page 3).  Read CMS’ Claims Reporting Made Simple  Learn more about PQRS at www.texmed.org/pqrs. Or call the TMA Knowledge Center at (800) 880-7955.