What Optometrists Need to be Aware of in 2015

by Applied Medical Systems

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)
  Report six Eye Measures (Report these on all Medicare patients with the condition listed):
  • Measures 19 and 117 for diabetic patients
  • Measures 12 and 141 for glaucoma patients
  • Measures 14 and 140 for macular degeneration patients
  This means that every Medicare patient encounter will generate at least 3 PQRS codes and usually 5 codes or more. For more information on these measures, see the AOA’s page on how to comply with PQRS in 2015: http://www.aoa.org/news/practice-management/how-to-comply-with-pqrs-requirements-in-2015?sso=y   How do I get started? Talk to your EHR vendor.
  • 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.
  Choose a Registry.    

What if my EHR doesn’t track PQRS measures?

Talk to your EHR representative. Make sure they are aware of how important it is to offer this feature and find out when it will be offered. Claims-reporting may disappear as soon as December 2015.   Then verify that your EHR is set up to code PQRS codes and add them to each encounter automatically. Although generally speaking automated coding will never take the place of a skilled certified coder, for PQRS reporting this is the best way to make sure all documented measures are reported. If your EHR doesn’t support automated PQRS coding, it is imperative to make sure the doctors and coding staff are trained to manually code these measures.  

What if I don’t have an EHR?

If you don’t currently have an EHR, it is recommended that you begin the process of selecting one as soon as possible. Not only will the claims-based reporting module soon disappear, ICD-10 is coming in October 2015, and paper charts and encounter forms will be difficult to say the least. Your representative at Applied Medical Systems will be happy to help you with the selection process.   In the meantime, you will need to report your PQRS via claims-based reporting. Make sure your coders are trained to do this at the time of service; if the claim is submitted without the proper codes, there is no way to recover that encounter.   I have more questions. Where can I find more information? Medicare’s website is chock-full of general information on PQRS reporting. For optometry-specific reporting, see the American Optometric Association’s website. For questions on how to sync your EHR with the Registry, contact your EHR’s tech support directly. And of course, if you have any questions at all, feel free to contact Anna Wade at Applied Medical Systems. [email protected] or 919-354-2946. We’ll do whatever we can to get you pointed in the right direction. Eligible encounters are encounters in which a patient is covered by Medicare and is being seen for an exam (92xxx or 99xxx codes). Additional diagnosis requirements apply for the general Eye Measures. http://www.webpt.com/blog/post/why-providers-should-go-registry-based-instead-claims-based