PQRS 2015

     In May of 2013, we published an introduction to the Physician Quality Reporting System (PQRS).  The reporting requirements for PQRS change every year: Here is the latest for 2015:

     Why report PQRS at all? All eligible professionals (EPs) who report PQRS in 2015 will avoid negative Medicare payment adjustments in 2017. In 2017, EPs who did not participate in PQRS and successfully report during the 2015 reporting period will have all their Medicare fee-for-service payments reduced by 2%. This applies to Medicare Part B covered professional services furnished by the EP during 2017 or any subsequent year. This 2% reduction is an increase over the previous years' negative payment adjustments. Even worse, the Value-Based Payment Modifier stacks on top of that to a reduction of up to 4% for solo practitioners or 6% for EPs in a group of 10+ EPs. In other words, you are facing a 4- 6% reduction in your Medicare payments in 2017. But you can escape all these reductions with PQRS reporting.

     How do you preserve your Medicare payments and report PQRS?

     • Report on at least 9 measures covering 3 NQS domains for at least 50% of the EP’s Medicare Part B FFS patients. EPs that see 1 Medicare patient in a face-to-face encounter must also report on 1 crosscutting measure. 

     • EPs that submit quality data for only 1 to 8 PQRS measures for at least 50% of their
patients or encounters eligible for each measure, OR that submit data for 9 or more
PQRS measures covering less than 3 domains for at least 50% of their patients or
encounters eligible for each measure will be subject to Measure-Applicability Validation (MAV).

     • EPs that see 1 Medicare patient (face-to-face encounter), but do not report on 1
cross-cutting measure will be subject to MAV. (See the Analysis and Payment
webpage)

     • Measures with a 0% performance rate will not be counted.

    Note that the cross-cutting measure reporting requirement is in addition to the requirement for other measures, so that you would be reporting 9 measures + 1 cross-cutting measure. Click here for a list of cross-cutting measures provided by CMS.

     MAV is a process that evaluates PQRS requirements for EPs in special circumstances. All EPs that do not meet the basic reporting requirements are subject to this process. MAV will either determine that the EP has reported unsatisfactorily and has not avoided the penalty, or that the EP, due to the limited scope of his or her practice, was not required to report as many measures as normal and has reported satisfactorily. 

    Now that you understand the guidelines, how do you actually report? There are several methods by which to report PQRS in 2015, but we strongly recommend that you use the PQRS Registry because of the increased requirements and the ease of tracking that this program offers. All of our clients, no matter which state they are in, can use NJ HiTec for PQRS reporting. Registration for NJ HiTec runs about $400 and it makes it easy for individual EPs to track their own status for incentive or penalty. To register, please visit http://www.njhitec.org/pqrs/ and choose the “click here to register” option. Once you register, please let us know so that we can call you about PQRS with instructions on your next steps.

Compiled by Laura Rowe