PQRS and Your Practice

PQRS and Your Practice

PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). 

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).  

Beginning in 2015, the program also applies a payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services.  This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS 

The Centers for Medicare and Medicaid Services finalized the use of the calendar year 2013 and 2014 reporting period to inform the 2015 and 2016 payment adjustments respectively. Eligible professionals, including physical therapists that do not satisfactorily report data on quality measures for the January 1, 2014-December 31, 2014 reporting period, will be subject to the 2.0% adjustment in their fee schedule amount in 2016.

 

Are you Ready  ?

 

HEDIS 2015

PQRS 2015

Quality Measures  

 

HPP Management Group, Corp. the titled-holder of Health Plans Path, Corp (HPP) and also the developers of the AccuChecker Product Line is a group of healthcare consultants servicing physicians and payers since 1983, and can assist you navigate through all these changes.

 

Contact our office for greater details.

 

PQRS Eligible Providers
Medicare Physicians / Practitioners	Eligible  For Incentive	Subject to Payment Adjustment
Doctor of Medicine	Y	Y
Doctor of Osteopathy	Y	Y
Doctor of Podiatric Medicine	Y	Y
Doctor of Oral Surgery	Y	Y
Doctor of Dental Medicine	Y	Y
Doctor of Chiropractic	Y	Y
Physical Therapist	Y	Y
Occupational Therapists	Y	Y
Qualified Speech-Language	Y	Y
Physician Assistant	Y	Y
Nurse Practitioner	Y	Y
Clinical Nurse Specialist	Y	Y
Certified Registered Nurse Anesthetist	Y	Y
Certified Nurse Midwife	Y	Y
Clinical Social Worker	Y	Y
Clinical Psychologist	Y	Y
Registered Dietician	Y	Y
Nutrition Professional	Y	Y
Audiologists	Y	Y

 

For more details, please call : 305-227-2383  or  1-877-938-9311

 

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PQRS 2014



   

 

PQRS Primer

The Centers for Medicare and Medicaid Services (CMS) established the PQRS program (formerly PQRI or Physician Quality Reporting Initiative) as part of the 2006 Tax Relief and Health Care Act. This act created a voluntary program where eligible professionals could report on quality health measures for covered professional services provided to Medicare beneficiaries and in return, earn an incentive for successful reporting. Right now PQRS is a pay‐for‐reporting system in which incentive payments are based on reporting quality measures instead of achieving clinical outcomes.

 

Why Report?

 Eligible professionals who successfully report PQRS measures are eligible to receive 0.5% of their total estimated Medicare Part B Physician Fee Schedule allowed charges for covered professional services furnished during 2012. The incentive will remain at 0.5% in 2013 and 2014 before being eliminated in 2015.

 

On the flip side, failure to successfully report on quality measures will result in a payment adjustment or reduction of your Medicare Part B Physician Fee Schedule amounts beginning in 2015. FSY 2015 may be a  year away; however, the 2015 payment adjustment will be based on PQRS performance in 2013.

 In other words, providers must be successful PQRS reporters in 2013 or face a 1.5% fee schedule reduction in 2015. This payment adjustment will increase to 2% in 2016 and subsequent years.

 

Steps for Successful Reporting
 

Your providers can be successful PQRS reporters by following these easy steps:

 

Ø  Determine Eligibility

Ø  Determine How You will Participate

Ø  Determine How You will Report

Ø  Select Your Measures*****

Ø  Review Measure Specifications and Reporting Criteria

Ø  Ready, Set, Report!

 

 

Tips for Successful Reporting

 Improve your chances of earning the PQRS incentive by following a few easy tips:

      Ø  Report more than the minimum

Ø  Check for remark code N365*****

Ø  Review the measures each year

 

Remarks:

***** Select Your Measures

option of reporting on 25measures groups [ Review the individual measures within the Measure Group ]

 

***** Check for remark code N365

After you submit your claims with the PQRS quality data codes, check your remittance advices for remark code “N365” which indicates that the PQRS data was submitted to the National Claims History file. It does not mean that the quality data codes reported were accurate or that you’re guaranteed to receive an incentive but does indicate that the transmission was successful.

 

In this age of declining reimbursement your practice cannot afford to pass up on incentive programs such as PQRS. Start reporting today so your practice can claim its share of incentive dollars and become a PQRS success!

 

For more information call AccuChecker at 305-227-2383

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ACK - Module for PQRS

Physician Quality Reporting System - PQRS

"PQRS gives participating EPs the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers." AccuChecker has P4P ( Pay For Provider ) assisting physicians capture the PQRS Measure.

 

AccuChecker has 2 new modules HEDIS & PQRS Measures.

For more details call 305-227-2383

 

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Physician Quality Reporting System { PQRS }

Physician Quality Reporting System (PQRS)

Measures codes contain information about Physician Quality Reporting System (PQRS) quality measures, including detailed specifications and related release notes for the individual PQRS quality measures and measures groups and other measures-related documentation needed by individual eligible professionals for reporting the PQRS measures through claims or qualified registry-based reporting.

The PQRS measure documents for the current program year may be different from the PQRS measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year.

At a minimum, the following factors should be considered when selecting measures for reporting:

• Clinical conditions usually treated
• Types of care typically provided – e.g., preventive, chronic, acute
• Settings where care is usually delivered – e.g., office, emergency department (ED), surgical   suite
• Quality improvement goals for 2014
• Other quality reporting programs in use or being considered

• 2014 Physician Quality Reporting System (PQRS) Implementation Guide – Provides guidance about how to select measures for reporting, how to read and understand a measure specification, and outlines the various reporting methods available for 2014 PQRS. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.
• 2014 Physician Quality Reporting System (PQRS) Measures List – Identifies and describes the measures used in PQRS, including all available reporting methods/options, corresponding PQRS number and NQF number, NQS domains, plus measure developers and their contact information