With healthcare’s shift towards value-based reimbursement models and an emphasis on quality of outcomes over quantity of services performed, there is also a push for physicians to dig deeper into their reporting. In order to encourage improved quality measures reporting, the Centers for Medicare & Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS). The program, created in 2007, has both non-reporting payment penalties and reporting payment incentives for physicians who treat patients covered by Medicare Part B. Those who don’t participate in 2014 face a 2.0 percent payment penalty for Part B claims which will be assessed in 2016. Likewise, those who do report quality measures via PQRS are eligible to receive a 0.5 percent payment bonus on all claims in 2014.
At first glance, the list of quality measures that can be submitted to PQRS is daunting, and many do not apply to specialty practices. Luckily for most specialty practices, the respective trade associations have done the legwork and have pulled out the applicable measures that can be used for submission. As such, specialty practices should check their association’s website for guidance in navigating the submission process.
However, all of these are based on a physician or group practice submitting the right data, via the right method, to the PQRS. Below are the various ways to submit data to PQRS to help practices avoid penalties:
1. EHR-based reporting. This is the preferred method of reporting data. For 2014, CMS discontinued the PQRS qualification requirement for data submission companies and Direct EHR vendors and instead have tied EHR data submission requirements to those that are aligned with the clinical quality measures of the Medicare EHR Incentive Program. Practices that employ a Direct Vendor EHR can submit quality data directly to CMS via the EHR. Alternatively, the practices can have their EHR partner submit the data for them serving as a Data Submission Vendor, which will also submit the data contained in the physician or practice EHR.
2. Registry-based reporting. Similar to filing income taxes via an online portal, physicians can submit their data to a registry. A registry is an online service where practices submit their information which in turn stores their information and then sends it to the PQRS on the physician’s behalf. However, the CMS prefers physicians directly submit via EHRs since they have identified some issues with registry-based reporting, mostly related to a lack of data at the patient level with registry submissions.
3. Claims-based reporting. This method uses the Medicare Part B electronic and paper claims forms to submit the quality measures at the same time as the claim is submitted, but it does require constant monitoring of the remittance advice received from CMS to ensure the quality data was received by the PQRS. Most medical associations suggest specialists choose another data submission method if they are just getting started with PQRS, because of this. Another drawback is that reporting via this method does not support the delivery of clinical information.
4. The Group Practice Reporting Option (GPRO). Specialty practices that are reporting to the PQRS as a group as opposed to individual physicians can use the GPRO web interface set up by CMS to submit their data. In order to use the GPRO option, practices must register their group practice by September 30, 2014, and meet other CMS eligibility requirements.
Whichever method physicians choose, they should get started as soon as they can. Submission is required for 2014 and failure to participate this year will automatically result in a 2 percent across-the-board reduction in your Medicare payments in 2016.
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