Say Yes to PQRS: 5 Things You Need to Know for Successful Reporting

by Michelle Trandel

Four years after its introduction, the PQRS program (Physician Quality Reporting System) continues to frustrate providers and office staffs.  Complaints about a lack of timely feedback and confusion about how to sort through the endless maze of information on the CMS website are just some of the challenges facing practices.  An understanding of the background and benefits of the program is the first step towards successful reporting.  So let’s review some program basics.

1.     PQRS is here to stay

The PQRS program, formerly PQRI (Physician Quality Reporting Initiative), was created in 2006 as part of the Tax Relief and Health Care Act.   This act required the creation of a voluntary program where eligible providers could receive an incentive for reporting on quality health measures with the goal that clinical data would help drive improvement in health care and reduce costs.  Currently, the PQRS program is focused on data collection.  Success is defined as whether providers satisfactorily report the measures; however, it is anticipated that PQRS will transition from a pay-for-reporting system to a pay-for-performance system in the future.

2.     Many are eligible to participate

The PQRS program is open to many different professionals including Doctors of Medicine, Osteopathy, Podiatry, Optometry, Oral Surgery, Chiropractic, and Dental Medicine.  Practitioners including Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists and Clinical Social Workers are also eligible as are Physical and Occupational Therapists.  One in five eligible professionals currently participate in PQRS with participation increasing 50% each year since 2007.  For a complete list of eligible professionals visit:

www.cms.gov/PQRS/Downloads/Eligible_Professionals03-08-2011.pdf

3.     Measures and more measures

For 2011 there are 190 individual measures and 14 measures groups that you can report.  Since 2007, participation has steadily increased as the program has expanded to include measures which appeal to a broader range of providers.  You have the option to either report on individual measures or measures groups.  A measures group is a collection of related individual measures such as diabetes, back pain, and heart failure.  How many measures and patients you must report on to be considered a successful PQRS reporter depends upon the reporting mechanism and reporting period you select as well as whether you report as an individual provider or as part of a group.  For a complete list of PQRS measures click on:

www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage

4.     No excuse not to participate

Just as there are a variety of measures, there are several reporting mechanisms, reporting periods, and participation options you may select. 

You can choose from three different reporting mechanisms:

  • Claims
  • Qualified registry
  • Qualified electronic health record

and two different reporting periods:

  • 12 month period from January 1, 2011 through December 31, 2011
  • 6 month reporting period from July 1, 2011 through December 31, 2011

and finally, three participation options:

  • Individual
  • Group of 200 or more eligible professionals
  • Group of 2 to 199 eligible professionals

Just as with measure selection, you must carefully consider which reporting mechanism and reporting period is the right solution for your practice.  For detailed information about the reporting options available click on the following:

www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp#TopOfPage

www.cms.gov/PQRS/22_Group_Practice_Reporting_Option.asp#TopOfPage

www.cms.gov/PQRS/03_How_To_Get_Started.asp#TopOfPage

5.     Successful reporting = Incentive!

An eligible provider who successfully reports PQRS measures will receive an incentive equal to a percentage of their total estimated Medicare Part B Physician Fee Schedule allowed charges for covered professional services furnished during the reporting period.  Currently, the PQRS program is voluntary; however, beginning in 2015 failure to successfully report will result in a payment adjustment of your Part B Physician Fee Schedule amounts for covered professional services.   The table below summarizes the incentive and adjustment schedule.

Year Incentive Payment Payment Adjustment
2011 1% N/A
2012 0.5% N/A
2013 0.5% N/A
2014 0.5% N/A
2015 0% -1.5%
2016 and subsequent years 0% -2.0%

 

In this age of declining reimbursement your practice cannot afford to pass up on payer incentive programs such as PQRS.  Start reporting today so you can claim your share of the incentive.   Tune into the tele-class on June 16, 2011 for step-by-step instructions and tips on how to make your practice a PQRS success!

© 2011 Efficiency in Practice

Michelle Trandel, CPC is a Senior Consultant with InHealth and a Billing and Coding Consultant with Indianapolis Medical Management.  For information on PQRS, register for “PQRS Made Simple: A Roadmap to Successful Reporting” or another of our tele-classes at http://efficiencyinpractice.com/seminars

This article can be reprinted freely online, as long as the entire article and this resource 

 



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