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.
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.
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
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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