Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

An Overview of PQRS Guidelines for 2015, Plus What’s New

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One point of interest for all physicians related to the release of the Medicare Physician Fee Schedule each year is the updated Physician Quality Reporting System (PQRS) guidelines, especially since 2013 when the program began penalizing unsuccessful reporters.

While Medicare updates their PQRS educational materials with specific guidelines, there are a few things to know about the 2015 program.

  • Successful PQRS submission for 2015 will allow eligible providers to avoid a 2 percent payment adjustment in 2017. Incentive payments are no longer available for PQRS.
  • Beginning in 2015, eligible professionals in Critical Access Hospital billing under Method-II (CAH-IIs) may participate in the PQRS using ALL reporting mechanisms available, including the claims-based reporting mechanism.
  • All reporting mechanisms used in 2014 are still available in 2015, though the number of claims-based measures continues to dwindle: claims; qualified registry; EHR (including direct EHR products and EHR data submission vendor products); the Group Practice Reporting Option (GPRO) web interface; certified survey vendors, for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS survey measures; and the Qualified Clinical Data Registry (QCDR).
  • For the 12-month reporting period for the 2017 PQRS payment adjustment, eligible professionals generally have to report on 9 measures across 3 National Quality Strategy (NQS) domains for at least 50 percent of the Medicare patients seen. If fewer than 9 measures apply, then professionals should report 1-8 measures, and the Measure Applicability Validation (MAV) will be applied. As in previous years, MAV evaluates if any additional measures should have been reported based on clinically related clusters, and if so, if there were more than 15 patients in the denominator of those additional measures, then the provider should have reported PQRS and will be subject to the 2 percent payment adjustment.
  • For the claims and registry reporting mechanisms, if an individual provider (or a group in the case of GPRO registry) sees at least one Medicare patient in a face to face encounter in 2015, then one of their required 9 PQRS measures submitted must be chosen from a list of 18 newly categorized cross-cutting measures.
  • The sample size for submission for groups electing the GPRO web interface mechanism in now 248, regardless of the number of eligible providers in the group.
  • Groups of 100 or more eligible professionals utilizing any of the GPRO reporting options must have all CAHPS for PQRS survey measures reported on their behalf via a CMS-certified survey vendor. CAHPS for PQRS is optional for groups of 2-99 eligible professionals.
  • Several commonly reported measures have been removed for 2015. Also, 20 new measures have been added, and several other measures have been updated or moved to a different NQS domain.

CIPROMS will continue to update our own educational materials and provide additional articles and guidance on PQRS as CMS releases more detailed information.

For more information about PQRS, visit the CMS PQRS webpage or review the 2015 Medicare Physician Fee Schedule Final Rule with Comment Period.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by 401(k) 2012 via Flickr used with permission under the Creative Commons License.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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