How to Avoid PQRS Negative Payment Adjustment in 2018

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.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

7 Responses to “How to Avoid PQRS Negative Payment Adjustment in 2018”

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  2. Jeni says:

    Great post!. Keep it up.

  3. Jeni says:

    Great work,keep it up.
    Thank you for your important additions

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  5. kittureddy says:

    Thank you for your important additions,
    But can you explain details of negative payment e.g. like payments reductions.
    I hope I will get from AAPC…!

  6. kittureddy says:

    Thanks for the post !!
    I need know details of PQRS system payments and Negative payments.
    Can anyone explain how to get PQRS system negative payment information from AAPC.

    Thanks you
    Kittureddy CPC

  7. ASaiz says:

    Hello and thank you for your comment. We are actively working on publishing more information as soon as we can. Our blog for right now is the best place to go to as we post information. Thank you.

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