How to Avoid PQRS Negative Payment Adjustment in 2018
All eligible providers who do not meet the criteria for satisfactory reporting or participating for the 2016 Physician Quality Reporting System (PQRS) will be subject to the 2018 negative payment adjustment “with no exceptions,” the Centers for Medicare & Medicaid Services (CMS) notes in its 2016 PQRS: Implementation Guide.
PQRS is a quality reporting program that uses negative payment adjustments to promote reporting of quality information by eligible providers (EPs) and group practices. The 2018 negative adjustment to claims payments made under the Medicare Physician Fee Schedule is 2 percent, and will be based on 2016 reporting.
Plan Your Route to Successful Reporting
The first thing you have to ask yourself is, “Am I an eligible provider or eligible group practice?” View CMS’ 2016 PQRS List of Eligible Professionals to determine your eligibility. If you are an EP, you must determine whether you want to participate in the PQRS as an individual or part of a group practice.
The next step is choosing a reporting mechanism. EPs may report using Medicare Part B claims, a qualified PQRS registry, a direct certified electronic health record, or a qualified clinical data registry. Eligible group practices may report using a qualified PQRS registry, a Web interface, a direct certified EHR, a certified EHR via a data submission vendor, or Consumer Assessment to Healthcare Providers and Systems for PQRS via a CMS-certified survey vendor.
After you have all those details straightened out, it’s time to choose which quality measures to report. New this year is a CMS web-based tool that EPs can use to search for measures to report for the 2016 PRQS Program. Choose at least nine individual measures across three National Quality Strategy domains or one measure group. EPs who have had at least one Medicare patient with a face-to-face encounter are also required to report one cross-cutting measure.
Lastly, you have to report by the deadline. Reporting for the 2016 PQRS program year ends December 31, 2016 for both group practices and EPs.
Before you do anything, download and review the newly-released 2016 Beginner Reporter Toolkit, available on the CMS website.