This Week – October 18, 2013

This Week in Washington DC:

The Centers for Medicare and Medicaid Services (CMS) has extended to today the deadline to register for the Physician Quality Reporting System (PQRS) “administrative claims-based” reporting mechanism and the PQRS Group Practice Reporting Option (GPRO).

What does this mean?

This will help certain individuals avoid a 2015 payment cut for failing to participate in PQRS this year and certain group practices avoid additional payment cut to the value-based payment modifier.

ACG has received many questions regarding how this extension impacts your practice and PQRS participation. Please find below some additional guidance:

  • Instead of actively making an effort to report PQRS measures, CMS allows providers to register and request that CMS review your Medicare fee for service claims forms and determine whether you could have successfully participated in PQRS (based on 17 CMS-selected individual PQRS measures).
  • Registering for this CMS-calculated “administrative claims” option will allow you to avoid 2015 payment cuts but you do not qualify for 2013 PQRS payment incentives.
  • Please click here to register: https://applications.cms.hhs.gov/
  • You need to sign up today if you wish to participate (you do not have to)

How does this announcement impact providers already reporting PQRS measures or GIQuIC participants?

  • It does not. This deadline is only for providers who thus far have not been planning to participate in PQRS.
  • This does not impact GIQuIC participants who intend to participate in the “registry-based” PQRS reporting option.
  • Please visit the GIQuIC website to learn more regarding how GIQuIC participants can successfully participate in PQRS (earn the incentive and avoid the payment cut) at no additional cost

How else can you avoid the 2015 payment cut for not participating in PQRS during the 2013 reporting year?

  • You can report 1 PQRS measure on a Medicare claims form, via a registry, or via a qualified electronic health record system. This will allow you to avoid 2015 payment cuts but you do not qualify for the payment incentives.

You should remember the following when reporting PQRS measures via a claims form: 1 patient, 1 measure, 1 claims form.

  • 1 Applicable Patient: A Medicare fee service patient.
  • 1 Applicable Measure: A service that qualifies for PQRS reporting purposes.
  • 1 Applicable Claims Form: A corresponding PQRS quality data code on the Medicare claims form.