It’s Not Too Late to Avoid PQRS Penalties

Eligible providers (EPs) who fail to successfully report Physician Quality Reporting System (PQRS) measures in 2013 will face a negative 1.5 percent adjustment to all professional services reimbursed under the Medicare Part B fee schedule, effective Jan. 1, 2015. If you’re not already participating in PQRS, you may still have time to avoid these penalties.

The Centers for Medicare & Medicaid Services (CMS) offers three ways to avoid penalties in 2015:

  1. Satisfactorily report and earn the PQRS incentive of 0.5 percent in 2013.
  2. Report one valid measure or measures group using a traditional reporting methodology of claims, or approved registry or electronic health record (EHR).
  3. Self-nominate for analysis by CMS under the administrative claims-based reporting methodology.

The deadline for option No. 3 has already passed; and to take advantage of option No. 1, you would have had to already report on at least three measures. But there’s still time to complete option No. 2: File using an approved registry or EHR and report just one valid measure for a single patient by year’s end.

One very basic measure that nearly all EPs should be able to report is “Documentation of Current Medications in the Medical Record” (PQRS measure 130). The medication list should include:

  • All prescriptions
  • Over-the-counter medications
  • Vitamin/mineral/dietary supplements
  • Herbal supplements

The record must contain the medication name, dosage, frequency, and route of administration. Information may be received from the patient, an authorized representative, or a caregiver or other available health care resource. There must be a CPT® or HCPCS Level II code associated with the visit during which the quality measure is reported. In addition, you must report HCPCS Level II code G8427 Eligible professional attests to documenting the patient’s current medications to the best of his/her knowledge and ability with a $0 or $0.01 charge (depending on what your billing system requires).

After submitting your claim/data through a qualified registry or EHR (no later than Dec. 31), keep an eye on your Remittance Advice/Explanation of Benefits for denial code N365, which validates that your PQRS codes were received into the National Claims History.

For complete information, visit the CMS website.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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