Revenue cycle management in many medical practices will soon have to take into account the Physician Quality Reporting System (PQRS). PQRS uses payment adjustments to encourage promoting of quality information by both group practices and eligible professionals (EPs).
Practices that successfully report clinical quality data for covered Medicare Part B fee-for-service (FFS) under Medicare's Physician Fee Service (PFS) will avoid a 2% penalty on Medicare reimbursements two years later. In other words, if you successfully report for the PQRS in 2015, you won't be penalized for reimbursements from Medicare in 2017. If you don't successfully report for PQRS in 2015, your Medicare reimbursements for 2017 will suffer a downward adjustment of 2%.
Report in 2015 to Avoid Penalties in 2017
When PQRS reporting started in 2013, EPs and group practices could earn a positive incentive by successfully participating in the program. However, that positive incentive period has ended. Successful participation starting in 2015 is a matter of avoiding penalties rather than earning incentives.
Like it or not, if your practice treats patients under Medicare Part B FFS reimbursement, the PQRS will have to be incorporated into revenue cycle management to avoid penalties two years hence. CMS has established reporting requirements that differ for individual EPs and group practices that participate in PQRS in 2015.
Reporting Options for Individual Eligible Practitioners
Individual EPs in 2015 have multiple reporting options. As one option, they may report at least 9 measures covering at least 3 National Quality Strategy (NQS) domains for at least half of their 2015 Medicare Part B FFS patients. If the EP sees at least one Medicare patient in an in-person encounter, he or she has to report on at least one measure contained in the "cross-cutting" measure set.
Individual EPs may also report via third party EHR or direct EHR data submission. Again, 9 measures across 3 NQS domains apply. Individual EPs may also report via a registry for Measures Groups reporting. They must report at least one measures group for at least 20 patients, the majority of whom must be Medicare Part B FFS patients.
Finally, individual EPs may report via Qualified Clinical Data Registry. Nine measures covering at least three NQS domains must be reported for at least 50% of Medicare Part B FFS patients. EPs must also report on at least two outcome measures such as resource use, patient experience, efficiency / appropriate use, or patient safety.