PQRS and What You Need to Know

What is the Physician Quality Reporting System (PQRS)?

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. When first started, CMS offered payment incentives to all Medicare providers who agreed to report on quality performance measures — formerly known as the Physician Quality Reporting Initiative (PQRI). The PQRS was initially a voluntary reporting program that provided a financial incentive for individual health care professionals, including psychologists, who participated in Medicare to submit data on specific quality measures to the Centers for Medicare and Medicaid Services (CMS). In 2015, the reporting program shifted from a voluntary program to a mandatory one in which penalties would be assessed for failure to participate.

What does PQRS involve?

PQRS involves reporting designated administrative codes on billing claims through a certified electronic health record (EHR) or a similarly qualified registry. In 2016, Healthcare providers who successfully participated in this program were listed on the new public Physician Compare webpage. One can find the exact specifications for the PQRS on the CMS PQRS webpage. Eligible professionals (EP) also received this downward payment adjustment in 2017.

The PQRS program continued throughout 2016 with reporting of 284 individual measures and 11 measured groups. For healthcare providers in the mental health specialties, this also included measures on depressive disorder, medication reconciliation, and screening for substance abuse. In addition, there was a dementia measure set available for use as a measure group.

What financial implications exist with PQRS?

To avoid being penalized, healthcare providers had to report on a minimum of nine individual measures or one measure group that encompasses three of the ten National Quality Strategy domains, applicable to their medical or surgical practice for at least 50% of their eligible patients for 2016 (Jan. 1 to Dec. 31). CMS had set a penalty of 2% of the total Medicare allowed charges for the period.

Suppose the healthcare provider feels that nine measures cannot be reported on, and he or she wanted to avoid being penalized in 2017. In that case, the healthcare provider had to volunteer to participate in the Measures Applicability Validation (MAV) process. The healthcare provider can then have the MAV process completed by CMS upon request. This pathway permits CMS to designate the appropriate measures for the provider. Any measure with a 0% performance was disregarded and not counted to report on a group; CMS has specific measure group requirements that must be followed.

What are the mechanisms for participation in PQRS?

There was no formal registration protocol to participate. Once one submitted quality data codes for the 2016 PQRS quality measures to CMS through claims, an electronic health record, or a qualified registry, that satisfied the criteria for participation in the 2016 program. Reporting for the PQRS is not meant to be involved or time-consuming. One only had to add a few codes to the electronic claim form used to submit to Medicare. More details are available on the CMS website. Information is also available from your local Medicare carrier.

Is the reporting done at the end of the year?

No, if you decide to report, you should start soon since you must report on 50% of the applicable cases during the 12 month reporting period. If you start late, this may prevent you from achieving this threshold, resulting in a failure to be eligible for the bonus payment.

How can MedTrainer assist an organization with PQRS reporting?

Since PQRS has become a mandatory reporting program for all Medicare providers, adherence to the policies set forth within the measures has become a crucial component to the functioning of a successful and compliant healthcare organization. In order to facilitate an atmosphere of accountability, your firm needs to implement a tool that will assist employees with a standardized format to encourage adherence to the reporting process. MedTrainer will enable your workforce to maintain accurate reporting records that will meet existing guidelines ensuring your organization is following protocols when reporting to Medicare and Medicaid.

Our cloud-based management system is an all-in-one solution to the ever-increasing complexities faced by healthcare organizations today. Your staff will no longer have to navigate multiple computer programs or complete traditional paperwork records when our software is utilized in the workplace. MedTrainer’s cloud-based initiative will empower individuals to work together as a team and provide a secure foundation for your organization’s growth far into the future. MedTrainer delivers a multitude of services that include exclusion database monitoring and medical staff credentialing. We can also track durable medical equipment lifecycles and assist with medical office appointment scheduling. Whatever administrative and management duties your healthcare firm requires, MedTrainer can offer a comprehensive data-driven solution with our cloud-based software. For more information about MedTrainer and what we can provide your healthcare organization, contact us today!