DEPARTMENTS: PRACTICE POINTS
Receiving friendly reminders can jog your memory to complete a project. Consider this your friendly reminder for 2 key Centers for Medicare & Medicaid Services (CMS) initiatives occurring in CY 2015 including Meaningful Use (MU), Physician Quality Reporting System (PQRS).
The following information for MU attestation can be found at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html.
First, the MU program started for eligible professionals (EPs) in 2011, and payments will continue through 2016. Eligible professionals can participate for up to 5 continuous years throughout the duration of the program. Second, the last year to begin participation and receive an incentive payment is 2014. To receive the maximum incentive payment, EPs must have started participation by 2012. Eligible professionals who demonstrate MU of certified electronic health record (EHR) technology can receive up to $43, 720 over 5 continuous years. Third, to qualify for incentive payments, EPs must successfully demonstrate MU for each year of participation in the program. And lastly, it is important to note that beginning in 2015 EPs who do not successfully demonstrate MU will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that an EP does not demonstrate MU, to a maximum of 5%.
The CMS has shared some of the important steps to take as you move through this EHR Incentive Programs, including the following:
- Determine your eligibility to participate in the Medicare and/or Medicaid EHR Incentive Programs.
- Prepare for registration.
- Register to participate in the Medicare and/or Medicaid EHR Incentive Programs. You must register with CMS online.
- Determine certification of your EHR system. To determine if an EHR system is currently certified, view the ONC Certified Health IT Product List.
- Meet meaningful use requirements and prepare for attestation.
- Attest that you have met the thresholds and all of the requirements of the Medicare or Medicaid EHR Incentive Programs.
- Retain proper documentation in case of an audit. Note: You may be audited prior to receiving payment.
- Continue reporting meaningful use data every year, and avoid Medicare payment adjustments.
In reviewing the CMS website specific to PQRS at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS, you will find a complete description of the reporting program. The PQRS is a quality reporting program that encourages individual EPs and group practices to report information on the quality of care to Medicare. The PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time.
In 2015, the program will apply a negative payment adjustment to individual EPs and PQRS group practices who did not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule–covered professional services in 2013. Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment.
There is a step-by-step guide to assist you in understanding the PQRS timeline: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html. Steps include the following:
1.Determine your eligibility. Find out whether you are eligible to participate in 2015 PQRS to avoid the 2017 negative payment adjustment. View the CMS 2015 PQRS List of EPs to determine your eligibility at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_List_of_Eligible_Professionals.pdf.
2.Determine whether you want to participate in PQRS as an individual EP or as part of a group practice:
- Individual EPs are identified on claims by their individual National Provider Identifier and Tax Identification Number (TIN).
- A group practice under 2015 PQRS is defined as a single TIN with 2 or more individual EPs who have reassigned their billing rights to the TIN. Group practices can register to participate in PQRS via the group practice reporting option (referred to as PQRS group practices) to be analyzed at the group TIN level.
3.Choose your reporting mechanism. Depending on whether you are participating in PQRS as an individual EP or as part of a PQRS group practice, you have several reporting mechanisms by which to submit your PQRS data.
4.Choose which quality measures to report. Individual EPs and PQRS group practices should choose at least 9 individual measures across 3 National Quality Strategy domains or 1 measures group as an option to report on measures to CMS (with the exception of group practice reporting option web interface). Individual EPs or PQRS group practices are also required to report 1 cross-cutting measure if they have at least 1 Medicare patient with a face-to-face encounter.
Friendly reminder: All PQRS measure specifications are updated annually and EPs will need to review the measure specifications for any revisions or measure retirement for the current program year. For assistance in understanding the step-by-step process to achieve MU or PQRS, e-mail me at firstname.lastname@example.org.