Wiki PQRS Reporting

[missyah20]

Just wondering how your anesthesia providers/groups are reporting their PQRS measures?

I was reading the proposed changes to the PQRS program and they have proposed to elminiate the reporting option to report on claims-based measures groups.

We are reporting via claims for our providers, because the cost of the registry was too expensive.

Does anyone have any insight into this. As always I usually only end up more confused after reading thru the CMS instructions for PQRS group reporting options.

Also - does anyone know what the CMS-calculated administrative claims reporting mechanism is all about?

Thanks for any additional insight!!

 

[dwaldman]

Have you checked the 2014 Physician fee schedule proposed rule. They have a lot information regarding up and coming regulations for future years for PQRS.

 

[dwaldman]

Statute Regulations Program Instructions
2014 Medicare Physician Fee Schedule Proposed Rule CMS-1600-P
CMS' proposals can be found in the 2014 Medicare PFS proposed rule. The 2014 Medicare PFS proposed rule was displayed in the Federal Register and was published on July 19, 2013. CMS will accept comments on the proposed rule until September 6, 2013 and will respond to the comments in a final rule with comment period to be issued by November 1, 2013. To view the 2014 Medicare PFS proposed rule, click here 2014 Medicare Physician Fee Schedule Proposed Rule.

http://www.cms.gov/Medicare/Quality...RS/StatuteRegulationsProgramInstructions.html

 

[dwaldman]

I found this on administrative claims based mechanism. It was also pulling up in the final rule for 2014 but I wasn't aware of what it was so below described it as not using G codes with claim based.

Below is from Practice Fusion's Emily Richmond

http://www.practicefusion.com/ehrbl...rs-administrative-claims-based-reporting.html


Avoiding the 2015 Payment Adjustment Using the Administrative Claims-Based Mechanism

Eligible professionals who have chosen not to meet the requirements for the PQRS payment incentive in 2013, and do not want to report G-codes on Medicare claims to avoid the payment adjustment via that mechanism, should register for the administrative claims-based reporting mechanism before October 15, 2013.

Providers who choose the administrative claims-based reporting mechanism in 2013 to avoid the 2015 PQRS payment adjustment will be evaluated on 19 quality measures for 100% of their applicable Medicare Part B Fee-for-service beneficiaries to whom the measure applies.

To register for the CMS Administrative Claims Based Reporting Option for PQRS before October 15, 2013, follow the steps below:
1.Register for an Individuals Authorized Access to the CMS Computer Services (CMS-IACS) account if you do not already have one, or add the appropriate IACS role if you already have an existing account. Registration for IACS is available at https://applications.cms.hhs.gov/ .
2.Go to https://portal.cms.gov/ and select the PV PQRS option, near the bottom of the page to register. For additional information, please go to http://www.cms.gov/Medicare/Medicar...backProgram/Self-Nomination-Registration.html

For assistance with the IACS sign up process or PQRS Reporting Option selection, please contact the CMS QualityNet Help Desk:

Monday – Friday: 8:00am – 8:00pm EST

Phone: (866) 288-8912 (TTY 1-877-715-6222)

Fax: (888) 329-7377
- See more at: http://www.practicefusion.com/ehrbl...ims-based-reporting.html#sthash.8hD5ccA7.dpuf

 

[dwaldman]

I still don't completely understand how it works but potentially the Qualitynet help desk could explain it if you call below is more info I found to about administrative claim based reporting mechanism.

Criteria 3: Elect to participate in the CMS-calculated administrative claims-based reporting mechanism. The election of the CMS-calculated administrative claims-based reporting is available only via the web from July 15, 2013 through October 15, 2013. Please use the information and instructions that follow to sign up for the CMS-calculated administrative claims reporting option: STEP 1: Prior to signing up for your PQRS reporting mechanism, both group practices and individuals will need to register for a CMS IACS account if they do not already have an IACS account, or add the appropriate IACS role if they already have an existing account. Registration for IACS begins June 3, 2013 at https://applications.cms.hhs.gov/. STEP 2: Beginning July 15th, go to https://portal.cms.gov/ and select the PV PQRS option, near the bottom of the page to register.
For additional information, please go to http://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/PhysicianFeedbackProgram/Self-Nomination-Registration.html.

 

[dwaldman]

Proposed Changes to the Criterion for Satisfactory Reporting of Individual Quality Measures via Claims for Individual Eligible Professionals for the 2014 PQRS Incentive For 2014, in accordance with §414.90(c)(3), eligible professionals that
satisfactorily report data on PQRS quality measures are eligible to receive an incentive equal to 0.5 percent of the total estimated Medicare Part B allowed charges for all covered professional services furnished by the eligible professional or group practice during the applicable reporting period. In the CY 2013 PFS final rule with comment period (see Table 91, 77 FR 69194), to maintain the reporting criterion with which individual eligible professionals are familiar, we finalized the same satisfactory reporting criterion for the submission of individual quality measures via claims that we finalized in previous years: For the 12-month reporting period for the 2014 PQRS incentive, report at least 3 measures, OR, if less than 3 measures apply to the eligible professional, report 1–2 measures, and report each measure for at least 50 percent of the eligible professional's Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. For an eligible professional who reports fewer than 3 measures via the claims-based reporting mechanism, the eligible professional would be subject to the Measures Applicability Validation (MAV) process, which would allow us to determine whether an eligible professional should have reported quality data codes for additional measures (77 FR 69188). For the reasons described below and based on our authority to revise the criteria for satisfactory reporting for the 2014 PQRS incentive under section 1848(m)(3)(d) of the Act, we propose to change the criterion for the satisfactory reporting of individual, claims-based measures by individual eligible professionals for the 2014 PQRS incentive as follows: For the 12-month reporting period for the 2014 PQRS incentive, report at least 9 measures, covering at least 3 of the National Quality Strategy domains, OR, if less than 9 measures apply to the eligible professional, report 1–8 measures, and report each measure for at least 50 percent of the Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. For an eligible professional who reports fewer than 9 measures via the claims-based reporting mechanism, the eligible professional would be subject to the MAV process, which would allow us to determine whether an eligible professional should have reported quality data codes for additional measures.

We note that this proposal would increase the number of measures an eligible professional is required to report via the claims-based reporting mechanism from 3 measures to 9. We understand that this is a significant increase in the number of measures an eligible professionals is required to report. However, we believe that the need to collect enough quality measures data to better capture the picture of the care being furnished to a beneficiary, especially when this data may be used to evaluate an eligible professional's quality performance under the Value- based Payment Modifier, justifies the increase in measures. We seek public comment on the proposed change to the criterion for the satisfactory reporting of individual quality measures via claims for individual eligible professionals for the 2014 PQRS incentive

 

[dwaldman]

Here is regarding the measure groups only be able to be thru registry. I didn't realize all these changes were in the 2014 rule and it came out in July. Maybe to much focus on billing and not preparing for quality reporting for 2014.

c. Proposed Changes to the Criterion for Satisfactory Reporting of Measures Groups via Claims for Individual Eligible Professionals for the 2014 PQRS Incentive In the CY 2013 PFS final rule with comment period, we finalized the following criteria for satisfactory reporting for individual eligible professionals to report measures groups via claims: Report at least 1 measures group and report each measures group for at least 20 Medicare Part B FFS patients. Measures groups containing a measure with a zero percent performance rate will not be counted (77 FR 69192). Since finalizing this criterion, we have recently published and analyzed the 2011 PQRS and eRx Experience Report, which provides a summary of PQRS reporting trends from 2007 through 2011, to determine where we may work to further streamline the reporting options available under the PQRS. The PQRS and eRx Experience Report stated that the number of eligible professionals who participated via claims-based measures groups reporting mechanism grew more than three-fold between 2008 and 2011. However, according to Appendix 8 of the PQRS and eRx Experience Report titled ‘‘Eligible Professionals who Participated by Reporting Measures Groups through the Claims Reporting Mechanism for the Physician Quality Reporting System, by Specialty (2008 to 2011),'' only 4,472 eligible professionals used this reporting option. Meanwhile, the Experience Report further shows that the option to report measures groups via registry has grown at an even faster rate with 12,894 participants in 2011. Therefore, in an effort to streamline the reporting options available under the PQRS and to eliminate reporting options that are not widely used, we are proposing to remove this satisfactory reporting criterion for the 2014 PQRS incentive. Please note that, since we are proposing to remove this reporting criterion, the only manner in which an eligible professional would be able to report a PQRS measures group would be via registry. We seek public comment on this proposal.