Groups Must Act Now to Avoid 2% PQRS Reduction

Groups Must Act Now to Avoid 2% PQRS Reduction

By Nancy Clark, CPC, CPC-H, CPB, CPMA, CPC-I

The Centers for Medicare and Medicaid Services (CMS) announced that registration for the 2015 Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) began on April 1, 2015 and will end on June 30, 2015. This option is available for groups of any number of eligible professionals (EPs). Registration is the first step in avoiding the 2 percent payment adjustment in 2017.

To register, a representative of the group must obtain an Individuals Authorized Access to the CMS Computer Services (IACS) account. There are six steps involved:

• New user registration, which involves entering personal information and a work-related email address
• E-mail verification, in which the applicant confirms a verification code sent to his/her email
• Contact information, where a role is selected and specific information for the applicant is entered
• Authentication questions, where questions and answers for account verification are selected
• Detail review, where the user can edit the information on the form, and
• Acknowledgement, where the user must acknowledge the accuracy of the information entered

Those providers choosing to report as a group must then choose from the following reporting mechanisms:

• Qualified PQRS Registry
• Web interface (for groups of 25+ only)
• Direct Electronic Health Record using CEHRT (Certified EHR Technology)
• CEHRT via Data Submission Vendor
• Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS Survey via a CMS-certified Survey Vendor (as a supplement to another GPRO reporting mechanism)

After groups have selected their reporting method, the guidelines for measures must be followed. This includes not only reporting the appropriate PQRS measures codes, but ensuring that documentation reflects the data submitted. The data reported applies to services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries, including Railroad Retirement Board and Medicare Secondary Payer.
Consider the following when selecting which measures to report:

• Clinical conditions usually treated by the group
• Types of care provided—for example, acute, chronic, preventive
• Settings in which care is delivered—an office, surgical suite, or emergency department
• Quality improvement goals for 2015
• Other quality reporting programs in use or being considered

A new condition for 2015 is the cross-cutting measure, which is required if the practice has at least 1 Medicare patient with a face-to-face encounter. These encounters include office visits, outpatient visits and surgical procedures. Measures codes have also changed for 2015, so ensure that the measures your practice chooses are current.

While future year payment adjustments have not yet been announced by CMS, it is clear that value-based reporting will continue. Preparation now will avoid the 2% penalty in 2017 and ready the practice for ongoing requirements. For more information on PQRS implementation, see http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_ImplementationGuide.pdf.

Nancy Clark

Nancy Clark

Nancy Clark, CPC, COC, CPB, CPMA, CPC-I, has over 20 years of experience in medical coding and billing, healthcare consulting, accounting, and business administration. She applies her skills to assist physician and hospital clients with revenue cycle management. Clark focuses on coding and documentation reviews, assistance with payer audits, and providing education for physicians and their staff. She is also an AAPC certified instructor, a contributing author to health care publications, and a presenter at seminars. Clark is a member of the Novitas Medicare Provider Outreach and Education Advisory Group and co-founder of the New Jersey Coders' Day Medical Coding and Billing Conference. She is proud to support the AAPC for recognizing the value of medical coding professionals and enjoys working with its members.
Nancy Clark

About Has 15 Posts

Nancy Clark, CPC, COC, CPB, CPMA, CPC-I, has over 20 years of experience in medical coding and billing, healthcare consulting, accounting, and business administration. She applies her skills to assist physician and hospital clients with revenue cycle management. Clark focuses on coding and documentation reviews, assistance with payer audits, and providing education for physicians and their staff. She is also an AAPC certified instructor, a contributing author to health care publications, and a presenter at seminars. Clark is a member of the Novitas Medicare Provider Outreach and Education Advisory Group and co-founder of the New Jersey Coders' Day Medical Coding and Billing Conference. She is proud to support the AAPC for recognizing the value of medical coding professionals and enjoys working with its members.

Leave a Reply

Your email address will not be published. Required fields are marked *