Quirk Insights Oct. 18th, 2013

OCT. 18,2013

Quirk Healthcare Solutions White Paper

Physician Quality Reporting System (PQRS) Incentive Today, or Penalty Tomorrow

Physician Quality Reporting System (PQRS)

INSIGHTS

About Quirk Healthcare Solutions Our team has worked with clients in industries ranging from one-physician clinics to nationwide organizations. Our staff includes physicians, nurses, MHAs, and MBAs to provide a multi-faceted view to all challenges. We’ve distilled what works, and we can provide an invaluable perspective. Everyone on our team brings real-world experience to the table.

We are doers, not theorists. This wealth of knowledge offers us a unique perspective into the strategies that work and those that don’t; we want to share the most effective ones with you.

PAGE 2 Physician Quality Reporting System (PQRS)

Contents In Brief

3

What is PQRS?

4

Who is an Eligible Professional?

4

Why should your organization participate in PQRS?

5

Which measures should you choose?

6

In Brief With Medicare cuts impending, providers and organizations must look for revenue from all possible sources. One source of revenue, originating with Medicare, is the Physician Quality Reporting System (PQRS). PQRS presents a dilemma, however, in that it imposes heavy administrative work that may seem to outweigh its benefits. The information below provides details on PQRS and the impact it may have on your practice.

PAGE 4 PQRS is a reporting program for services provided to Medicare beneficiaries. It uses a combination of incentive payments and payment adjustments to promote reporting of quality information by Eligible Professionals (EPs). The program began in 2007 as part of the Tax Relief and Health Care Act. Physicians who participate are eligible to earn incentive payments for their participation through 2014. Beginning in 2015, there will be a financial penalty for non-participation.

PQRS comprises over 200 separate quality measures. These measures are usually defined as applicable to patients based on combinations of CPT codes, ICD codes, and patient age at the time of the encounter.

Who is an Eligible Professional?

In order to be considered an Eligible Professional, the provider must render services that are payable under the Medicare Part B Fee Schedule. Additionally, the provider must use his/her individual NPI number to submit claims.

EPs include providers in the following categories: Doctor of Medicine Doctor of Optometry Doctor of Chiropractic

Doctor of Podiatric Medicine Doctor of Oral Surgery

Doctor of Osteopathy Doctor of Dental Medicine

Physician Assistant

Nurse Practitioner

Clinical Nurse Specialist

Certified Nurse Midwife

Clinical Social worker

Clinical Psychologist

Registered Dietician

Nutrition Professional

Audiologist

Physician Quality Reporting System (PQRS)

What is PQRS?

Why Should Your Organization Participate in PQRS? There are three principal reasons to consider participation in PQRS: 1) Reporting on quality measures enables both internal and external validation of quality of care.

providers must participate successfully in 2013 to avoid a negative payment adjustment in 2015. See the Incentives and Adjustments

2) Reimbursements for successful participation will be available from the

schedule below for details.

Centers for Medicare & Medicaid Services (CMS) through 2014, with

3) CMS posts the results of physician participation in PQRS on their

penalties for non-participation beginning in 2015 and continuing

Physician Compare website, including provider performance ratings,

thereafter. While the reimbursement rate will vary based on the

and will soon be publishing individual performance ratings on

individual Medicare fee schedule for 2012–2014, the penalties invoked

specific quality measures. With a public record available to compare

in 2015 and beyond will be significant. The penalties for failing to

provider performance directly, there could be a significant impact on

participate successfully will be assessed with a two-year delay, so

associated facility revenues based on a physician’s quality rating.

PQRS Incentives & Adjustments Schedule Reporting Year

Submission Due

PQRS Incentive %

PQRS Incentive Lump-Sum Payment

PQRS Adjustment %

PQRS Adjustment Applied to Fee Schedule (Year)

2012

2013

2014

2015

2016

Q1 2013

Q1 2014

Q1 2015

Q1 2016

Q1 2017

0.5%

0.5%

0.5%

0%

0%

Q4 2013

Q4 2014

Q4 2015

(1.5%)

(2%)

(2%)

(2%)

2015

2016

2017

2018

Which measures should you choose?

Choosing the right measures is key to successful PQRS reporting. Although there are over 200 standardized quality measures, many of them will not be relevant to your specific specialty or practice. So how do you choose?

To ensure that the 50% threshold requirement is met on at least three PQRS quality measures, a provider should choose measures for services that are performed frequently. Other considerations include: • Determining how difficult the documentation requirements will be for each measure.

• Deciding which measures are most relevant to your practice.

• Deciding which measures show the best performance based on your actual data.

Getting Started The first decision is to choose between incentive or penalty. Once you make the decision to participate in PQRS, you should begin the planning process as soon as possible. This means selecting measures and planning for implementation. Planning now will enable you to submit claims in 2014 as quickly as possible. Early claim submission will help you reach the 50% threshold requirement for financial incentives.

For more information on how Quirk Healthcare Solutions can help automate your practice and bring you into compliance with the ICD-10 changeover, contact us at 855.WE.QUIRK or info@quirkhealthcare.com

www.quirkhealthcare.com

PAGE 6 Physician Quality Reporting System (PQRS)

Suggested Action Items

2MILLION

$

in Meaningful Use payments

five star rating

Solving the problems of tomorrow Quirk solves problems plaguing healthcare organizations today and foresees the problems of tomorrow. At each level, our subject matter experts provide guidance and assistance to maximize efficiency, improve outcomes, and ensure the greatest return on investment.

Partnering with us enables you to continue to focus on core business objectives without compromising your time and strengths. We bring additional strengths and value to your work through a full range of services designed to keep your organization at the leading edge.

For more information on how Quirk Healthcare Solutions can help your practice contact us at 855.WE.QUIRK or info@quirkhealthcare.com

www.quirkhealthcare.com

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