2016 may be the last year of PQRS reporting
2016 may be the last year of PQRS reporting (it is being rolled into the Merit-based Incentive Payment System beginning with 2017 reporting), but that doesn?t mean one can?t avoid the 2018 PQRS negative payment adjustment. The PQRS reporting period reflects a two-year gap, so this year?s reimbursement is a reflection of 2014 reporting; and 2016 reporting will affect 2018 reimbursement, with either positive, neutral, or negative results.
It should be noted that 2016 reporting will affect 2018 reimbursement, with either a positive, neutral, or negative result.
The first step to successful reporting is determining eligibility.
Eligible providers are:
- Physicians,
- Physician assistants,
- Nurse practitioners,
- Clinical nurse specialists and
- Certified nurse anesthetists.
Many practices experience confusion when selecting measures. The submission technique will determine what measures are available to your practice. One will require to submit the measures applicable to your services regardless of your submission method.
One must submit nine measures across three domains with one cross cutting measure. If one doesn?t meet that requirement, the fate for success or failure will be determined by the Measure-Applicability Validation system (MAV). If one has fewer than the required nine measures, report on 50 percent or more of your eligible patient population successfully and will succeed under the MAV process. It would be beneficial to set up and retrieve reports through Enterprise Identity Management (EIDM) to periodically check reporting progress.
There is also a ?Measure Groups? option. This option focuses on conditions and specialty procedures, and allows you to submit a 20-claim sample, of which 11 must be Medicare Part B, Railroad Medicare, or secondary Medicare; the remaining nine can be any other Medicare product. If you have more than 20 claims, over 50 percent must be Medicare Part B, Railroad Medicare, and/or secondary Medicare. Many EPs find that the Measure Groups option doesn?t fit into their scope of practice, and have to report individual measures. This method is by registry only.
Claims Reporting:
This method is available to individual EPs, and it is free. The disadvantage of claims submission is that you can?t add data after a claim has been submitted to Medicare, and you must report on 50 percent of your Medicare Part B, Medicare secondary, and/or Railroad Retirement beneficiaries.
Qualified Registry Reporting:
This method is available to both individual EPs and group practices. Registry reporting also allows you develop a PQRS measure grid, collect the data, and pick and choose those claims that will qualify for successful reporting at the end of the year.
The only down side to registry reporting is that (in most cases) they are not free; however, sometimes you can get a discount if you use a registry endorsed by your specialty association.
Electronic Reporting Using CEHRT:
If you?re set up to attest in the Medicare Electronic Health Record (EHR) Incentive Program, you?re well on your way to successful PQRS reporting. Both individual EPs and group practices may submit PQRS quality measures data directly from their certified EHR technology (CEHRT), or extracted from their CEHRT to a qualified EHR data submission vendor who submits on behalf of the EP or group practice. Make sure to have good communication with your vendor to increase your success rate.
Qualified Clinical Data Registry (QCDR) Reporting:
A QCDR will complete the collection and submission of PQRS quality measures data on behalf of individual EPs and group practices. The reporting method differs from qualified registries in that it is not limited to measures within PQRS. Each QCDR has many more measures available to the specialty. The important thing to remember is that you must report all your claims data through the QCDR regardless of the payer. The 2015 Medicare Physician Fee Schedule final rule includes detailed information regarding this reporting mechanism.
Report Data:
The reporting method will determine the data submission deadline.