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GE Healthcare Camden Group Insights Blog

Review Your 2014 PQRS Interim Claims Feedback Data

Posted by Matthew Smith on Jul 24, 2014 11:23:00 AM

PQRSIf you are an individual eligible professional who has reported at least one PQRS quality measure this year via claims-based reporting, you can now view first quarter data (January 2014 – March 2014) regarding your submission(s) using the 2014 PQRS Interim Feedback Dashboard.  

The Dashboard will let you monitor the status of your claims-based measures and measures group reporting and see if you are meeting the PQRS reporting requirements. You can log-in and review your 2014 PQRS data on a quarterly basis.

You can access the Dashboard through the Physician and Other Health Care Professionals Quality Reporting Portal, with Individual Authorized Access to the CMS Computer System (IACS) sign-in.

Dashboard Resources
The following CMS resources can help you access your 2014 PQRS interim feedback data:

The Dashboard only provides claims-based data for 2014 interim feedback.

The Dashboard does not provide:

  • Final data analysis for full-year reporting
  • Indication of incentive eligibility or subjectivity to payment adjustment/value modifier
  • Data from other CMS programs
  • Data submitted via methods other than claims

Data submitted via other 2014 reporting methods will be available for review in the fall of 2015 through the final PQRS feedback report or the QRUR for 2014 PQRS GPROs.

For More Information about PQRS
For more information about participating in PQRS, visit the PQRS website. For additional support or questions, contact the QualityNet Help Desk.

Topics: Quality Reporting, Interim Feedback Dashboard, Physician Quality Reporting System, PQRS

How to Participate in the 2013 PQRS-Medicare EHR Incentive Pilot

Posted by Matthew Smith on Sep 17, 2013 3:40:00 PM

PQRS, EHRCMS has released a new fact sheet on how to participate in the 2013 Physician Quality Reporting System (PQRS) Medicare Electronic Health Record (EHR) Incentive Pilot Program. The PQRS-Medicare EHR Incentive Pilot Program allows eligible professionals to meet the clinical quality measure (CQM) reporting requirements for the Medicare EHR Incentive Program while also reporting for the PQRS program by submitting their CQM data electronically.

PQRS-Medicare EHR Incentive Pilot Participation

Eligible professionals who wish to participate in the electronic reporting pilot must submit 12 months of CQM data. Participants must submit the data between January 1, 2014 and February 28, 2014. Below are steps to guide you through participation in the pilot.

  1. Determine eligibility for participation in PQRS and the EHR Incentive Programs
  2. Indicate intent to participate in the pilot program through the EHR Incentive Program Attestation Module
  3. Determine which clinical quality measures apply 
  4. Verify your EHR/data submission vendor is PQRS-qualified and your EHR is certified
  5. If you are not using a data submission vendor, register for an IACS account (for direct EHR submission only) 
  6. Document patient information in EHR system 
  7. Generate required reporting files 
  8. Test data submission
  9. Submit quality data by February 28, 2014 

-By data submission vendor, OR 
-Directly through your EHR

10. Complete EHR Incentive Program attestation by February 28, 2014 

Opting Out

If you signed up for the electronic reporting pilot, but are unable to continue or determine that you no longer wish to participate, you may opt-out and complete your attestation through the EHR Incentive Program Attestation System. If you have questions please contact the QualityNet Help Desk:

  • By Phone: 866-288-8912 (available 7 a.m.- 7 p.m. CST, Monday-Friday, TTY 877-715-6222) 
  • By e-mail at qnetsupport@sdps.org

Receiving Payment

If you complete the pilot, successfully attesting to meaningful use and submitting your PQRS data properly, you should receive a payment for your 2013 participation in both PQRS and the Medicare EHR Incentive Program. Payment will not be received prior to 2014, as you must submit 12 months of CQM data (Jan. 1-Dec. 31, 2013).

Want more information about the EHR Incentive Programs or PQRS?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs. You can also visit the PQRS Incentive Program website or contact the Help Desk.

 

Topics: EHR, Medicare, CMS, PQRS, CQM

Leaving Money on the Table? Take Advantage of PQRS & eRX Incentives

Posted by Matthew Smith on Jul 19, 2013 11:00:00 AM

PQRS, eRX, e-prescribe, ehr incentives, ehrThe average 2011 payment for PQRS and eRX was $935 and $1,009, respectively. If your practice is not taking advantage of these EHR incentive payments, you are missing "free income" and leaving money on the table that should be a byproduct of your workflow

This report summarizes the reporting experience of eligible professionals in the PQRS and eRx programs in 2011, historical trends, and preliminary results for the 2012 program year.

  • 280,229 eligible professionals participated individually in the 2011 PQRS
  • Total of $261,733,236 in PQRS incentive payments was paid by CMS for the 2011 program year
  • 282,382 eligible professionals participated in the 2011 eRX incentive program (116% increase from total participants in 2010)
  • $285,049,103 in eRx incentive payments was paid for the 2011 program year
  • 135,931 eligible professionals were subject to the 2012 eRx payment adjustment because they did not qualify for exemption, meet exclusion criteria, or did not meet eRx reporting requirements in the first half of 2011.
  • The average PQRS incentive payment per provider is $935
  • Average eRx incentive payment per provider is $1009

Number of Eligible Professionals Who Qualified for an Incentive: Physician Quality Reporting System Results (2007 to 2011) and eRx Incentive Program Results (2009 to 2011)

PQRS Incentive Payment

About the Physician Quality Reporting System

What is it?

PQRS is the Physician Quality Reporting System.  It is ultimately a way to encourage the reporting of quality information by eligible professionals.  PQRS is made up of incentive payments and payment adjustments to eligible professionals.

How are incentives determined?

Eligible professionals (EP) are identified on their claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN).  Incentive payments are given when an EP reports data on quality measures (determined by CMS) for their services provided to Medicare Part B Fee-for-service (FFS) beneficiaries.  A payment adjustment will begin in 2015 to all EPs who do not report data on quality measures for these covered services. 

What is being reported?

As mentioned above, incentive payments are based off of quality measures being reported.  The Centers for Medicaid and Medicare services (CMS) implements Physician Quality Reporting through regulations published in the Federal Register.

How Do I participate?

To participate in the Physician Quality Reporting you must qualify.  There is certain criteria to qualify you and it is specified by CMS for a particular reporting period. 

2013 Physician Quality Reporting

EPs may choose to report information on individual Physicians Quality Reporting quality measures or measures groups:

  1. To CMS on their Medicare Part B claims
  2. To a qualified Physicians Quality Reporting registry
  3. To CMS via a qualified electronic health record product
  4. To a qualified Physician Quality Reporting data submission vendor

    If you are an EP and you meet the criteria and report the quality measures in one of the ways listed above for services during the 2013 reporting period you will qualify to earn a Physician Quality Reporting incentive payment equal to 0.5% of your total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.

     EHR Incentives, PQRS, eRX, EHR

    Topics: EHR, PQRS, e-prescribe, eRX, EHR Incentive Payments

    Timing of Quality Reporting Alignment at CMS

    Posted by Matthew Smith on May 7, 2013 12:09:00 PM

    CMS, ReportingIn order to reduce the burden of multiple quality reporting initiatives, CMS is working to align quality measurement across programs. As part of the eHealth initiative, CMS has created a timeline of quality measurement alignment for both eligible professionals (EPs) and eligible hospitals.

    This timeline includes upcoming activities that CMS is taking or that EPs and eligible hospitals can take to prepare for this alignment.

    For Eligible Hospitals
    By 2013:

    • Complete alignment of Hospital Value-Based Purchasing (HVBP) and Inpatient Quality Reporting (IQR) Program CQMs reported on Hospital Compare.
    • Implement the Medicare EHR Incentive Program Electronic Reporting Pilot for Eligible Hospitals and Critical Access Hospitals. (Note: This electronic reporting pilot will be the basis for electronic reporting in other reporting programs.)

    By 2014:

    • IQR will introduce EHR-based reporting. Additional details will be included in the Fiscal Year (FY) 2014 Inpatient Prospective Payment System proposed rule that is targeted for publication later this year.

    Beyond 2014:

    • CQMs will be transitioned to electronic EHR-based reporting in the Medicare EHR Incentive Program, and then to IQR and other hospital reporting programs.

    For EPs
    By 2013:

    • Individual EPs: Implement the PQRS-EHR Incentive Program Pilot (Note: EPs can fulfill the CQM component of meaningful use for the Medicare EHR Incentive Program as well as PQRS if reported using QRDA I).

    Group Practices:

    • Align PQRS Group Practice Reporting Option (GPRO) web interface CQMs with those in the ACO GPRO measure set and the Physician Value-Based Modifier (VBM) GPRO measure set.
    • Align PQRS with the VBM, whereby the quality component of the 2015 VBM for group practices with 100 or more EPs that elect quality tiering will be based on the groups' performance on PQRS measures.

    By 2014:

    • Individual EPs: PQRS EHR reporting options align, including CQMs, reporting criteria, and reporting mechanism in the calendar year 2013 Physician Fee Schedule and the Stage 2 rules for the Medicare EHR Incentive Program.
    • Group Practices: Group practices participating in the PQRS GPRO or Medicare ACOs using certified EHR technology and reporting via the GPRO web interface fulfill the requirement of the CQM component of meaningful use for the EHR Incentive Programs.

    Group practices can also report the CQMs as a group directly to CMS to fulfill the requirement of the CQM component of meaningful use for the EHR Incentive Program.

    Learn more about quality program alignment efforts at CMS by visiting www.CMS.gov/eHealth.

    Meaningful Use, Meaningful Use Incentives

    Topics: EHR, CMS, PQRS, CQM, GPRO, Eligible Hospitals, Eligible Professionals

    EHR Audits & Medicare Enrollment: The Latest Provider Update from CMS

    Posted by Matthew Smith on Apr 23, 2013 1:15:00 PM
    EHR Audits, CMSThe Centers for Medicare & Medicaid Services (CMS) is the Federal agency under the Department of Health & Human Services (HHS) which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. The CMS EHR Incentive programs are currently open programs for eligible professionals and hospitals to receive incentive payment for participation. Checking in on CMS will be a regular weekly post to keep up with communication coming from CMS on information about these and other related programs.

    What Providers Need to Know about EHR Audits

    All eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) attesting to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit. CMS and its contractor, Figliozzi and Company, perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers who are participating in the EHR Incentive Programs. States perform audits on Medicaid providers participating in the Medicaid EHR Incentive Program. In addition to the post-payment audits that have been conducted since 2012, CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.

    CMS to Begin Accepting Suggestions for Potential PQRS Measures and Measures Groups in May

    CMS will begin accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rule-making years. CMS is seeking a quality set of measures that are outcome-based and fall into one of the National Quality Strategy (NQS) Priorities domains where there are known measure and performance gaps. The measure gaps that CMS most wishes to fill include clinical outcomes, patient-reported outcomes, care coordination, safety, appropriateness, efficiency, and patient experience and engagement.

    Measures submitted for consideration will be assessed to ensure that they meet the needs of the Physician Quality Reporting Program. In addition, CMS encourages eligible providers to submit measures that do not have an adequate representation within the program for participation. When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Each measure submitted for consideration must include all required supporting documentation. Documentation requirements will be posted on the Measures Management System Call for Measures web page on or around May 1, 2013. Only those measures submitted in the provided format will be accepted for consideration. 

    Important Medicare Enrollment Date

    Effective May 1, 2013, physicians who refer or order services for Medicare patients will be required to be enrolled in Medicare. Claims submitted on or after May 1st for a physician who referred or ordered services for a Medicare patient but who is not enrolled in Medicare will be denied. Providers should enroll online through the Provider Enrollment, Chain, and Ownership System (PECOS) or can mail enrollment application CMS-8550. Physicians who have a valid opt-out affidavit on file are not required to enroll in Medicare. Visit the CMS web site for more information.

    CMS Listening Session on Billing and Coding with EHRs – Save the Date

    Friday, May 3, 9am – 2pm ET, Registration Now Open.

    CMS and ONC will convene a meeting of interested stakeholders, including providers, health information technology vendors, press and others to discuss electronic health records (EHRs), the increase in code levels billed for some Medicare services, and appropriate coding in an increasingly electronic environment. Invited speakers will discuss key issues such as the impact of EHRs on high quality clinical care, provider efficiency, and coding, as well as coding challenges and opportunities facing various groups, including hospitals, clinicians, and other interested stakeholders.

    For this Listening Session, you have the option to:

    1. Attend in-person.
    2. Call-in to listen.
    3. Watch a live stream via the web.
    Electronic Health Records EHR Assessment

    Topics: CMS, PQRS, EHR Audit, Medicare Enrollment

    Infographic: Stay out of the Penalty Box & Avoid Reimbursement Cuts

    Posted by Matthew Smith on Apr 4, 2013 11:30:00 AM

    PQRS, CMS, Penalty, Medicare CutsHealthcare organizations that fail to take certain steps this year face Medicare reimbursement cuts of 2% (or more) in 2015 and beyond. That’s because among other areas, the CMS Physician Quality Reporting System (PQRS) and ePrescribing (eRX) programs are shifting from bonus to penalty programs to insure compliance. More than 80% of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue.

    This infographic from Medical-Billing.com highlights these changes and what healthcare entitities need to do to protect their practices.

    "PQRS

    Topics: Medicare, CMS, Infographic, PQRS, Reimbursements, Medicare Reimbursements

    Study: Most Medicare Docs Set to Face PQRS Performance Penalties

    Posted by Matthew Smith on Jan 10, 2013 12:41:00 PM

    PQRSA new study shows that more than 80% of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue.

    The Harvey L. Neiman Health Policy Institute found Tuesday that fewer than one in five Medicare providers meet the program's Physician Quality Report System (PQRS) standards and are eligible for related bonus payments.

    This point spells trouble for Medicare providers as the bonus program is converted to penalties for failing to meet PQRS requirements this year, researchers wrote. 

    "Near-term improvements in documentation and reporting are necessary to avert widespread physician penalties," said Richard Duszak, CEO of the Harvey L. Neiman Health Policy Institute, in a statement.

    "Compliance with PQRS requirements has improved each year but more physicians need to act now: Their performance in 2013 will dictate penalties for 2015."

    The requirements encourage doctors to improve patient care by following evidence-based clinical procedures, such as administering aspirin to someone suffering a heart attack or ordering a tuberculosis screening for rheumatoid arthritis patients.

    The new study found that U.S. radiologists performed better than other Medicare providers in 2010, with nearly 24% of imaging docs eligible for PQRS incentives that year compared to 16% of others.

    "As it stands, in 2016, radiologists collectively may face penalties totaling more than $100 million. Although not a specific part of this analysis, penalties for nonradiologists could total well over $1 billion," Duszak said.

    Doctor groups like the American Medical Association have urged federal health officials not to implement the PQRS penalties for 2013. The fines would be levied in 2015.

    Last year, most Medicare doctors who were eligible for quality bonuses did not participate in the incentive program at all.

    Tuesday's study was published online in the Journal of the American College of Radiology.
    The Harvey L. Neiman Health Policy Institute studies issues relevant to that field.

    Topics: Medicare, Physician's Quality Report System, Research, PQRS

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