Big changes are afoot in the world of PQRS for Optometrists, among others. It’s important to be aware of the government’s reporting requirements in order to avoid penalties.
What is PQRS?Physician’s Quality Reporting System. This system was created by CMS to “promote reporting of quality information” by Medicare providers. Do I have to participate? Participation is not mandatory yet. However, failure to have successfully reported in 2014 will result in a 2% reduction in all Medicare payments paid in 2016. Failure to report in 2015 will result in a further reduction in 2017. For example: if an office’s total annual Medicare compensation is $55,000, a 2% reduction translates to $1100.00 less revenue. Some offices with very small numbers of Medicare patients decide that the cost of reporting is higher than the penalty assessed. It is a good idea to run this calculation for your office and compare it to your reporting costs.
What are the 2015 reporting requirements?In 2014, optometrists were required to successfully report 3 measures for at least 50% of their eligible encounters. The 2015 requirement is to report on at least 9 measures and must now include cross-cutting measures (these are non-eye-specific measures, such as medication tracking or tobacco use, that apply to all Medicare patients.) Which measures should I choose to report? There are a limited number of eye-specific measures; therefore, optometrists are forced to use more cross-cutting measures in order to reach the required nine. The list for 2015 has not yet been published, but based on the 2014 measures, the breakdown will look like this: Report three Cross-cutting Measures (Report these on all Medicare patients):
- tobacco use and counseling (236)
- hypertension follow-up (226)
- medication listing (130)
- Measures 19 and 117 for diabetic patients
- Measures 12 and 141 for glaucoma patients
- Measures 14 and 140 for macular degeneration patients
- Many EHRs track the data needed to report PQRS measures to CMS, eliminating the need to remember to add a large number of PQRS reporting codes to every claim. Studies have shown that claims-based reporting is less accurate and more likely to fail than EHR or Registry-based reporting. Not only that, claims-based reporting must be done at the time of service, and if it is missed there is no way to add the data after the fact; registery or EHR reporting data does not have to be submitted until the end of the year.
- The Center for Medicare and Medicaid Services (CMS) has some great information on how to use your EHR to report PQRS: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic-Health-Record-Reporting.html
- Some EHRs offer a Registry as a feature, or have agreements with certain registries. Talk to your EHR rep about those, or see below.
- Although you can send your data directly from your EHR to CMS, there are vendors you can use to help manage the large amount of data, and to make sure you are on track for successful reporting.There are many approved registry vendors, although not all vendors support all specialties. Go to this link for a list of CMS approved registry vendors. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014QualifiedRegistries.pdf
- For even more information, see this link from CMS called Registry Reporting Made Simple: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_PQRS_Registry_Made_Simple_F01-08-2014.pdf