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By Steve Elliott, COO, Medical-Billing.com

On November 1, 2012, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2013 Medicare Physician Quality Reporting System (PQRS). To date, the PQRS has been a voluntary program, offering incentives to physicians who report on a designated set of quality measures. While the PQRS will remain voluntary, starting with the 2013 reporting year, it will include both incentives for 2013 (+0.5%) and penalties for non-participation in 2015 (-1.5%)For complete information on PQRS reporting options for receiving the 2013 incentive payment (and avoiding the 2015 payment adjustment) click on the following link:  http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013MLNSE13__AvoidingPQRSPaymentAdjustment_020113.pdf

2015 penalties may also be avoided by electing to participate in the “administrative claims-based reporting mechanism” by October 15, 2013.  However, details on how to choose this option have not yet been published by CMS.

Our recommendation is for our clients to pursue reporting options for receiving incentive payment.  To this end we offer the following summary for your decision making, which includes:

1. Selection of Individual Professional or Group Practice reporting

2. Selection of Reporting Mechanism

3. Selection of Measure Type(s)

Individual or Group Reporting

Most of our clients will likely report at the Individual Professional level.  Group Practices are limited to reporting for Individual Measures only and must report via Registry (see Measure Type and Reporting Mechanism discussion below).  Unless Groups have already initiated PQRS reporting using an EHR for 2013, it is likely too late in the year to begin.

Reporting Mechanism

There are three ways to report PQRS data: Claims, Registry or Direct via Qualified EHR Product (or Qualified EHR Data Submission Vendor).  We can assist with claims-based reporting as part of our billing services.  However, to report using Registry or Direct via EHR will necessitate working directly with your EHR vendor.

Measure Type(s) (for Claims-Based Reporting)

There are two options for reporting PQRS “Measures” – Individual and Group.  There are 259 Individual PQRS Measures and 22 Measures Groups for traditional reporting options.  If the Individual option is selected, a minimum of 3 Measures must be reported and for at least 50% of the eligible professional’s Medicare Part B patients.  If a Measures Group option is selected, only 1 Group is required and for at least 20 Medicare Part B patients.

Based on our conversations to date with clients, it seems there is much greater interest in selecting the Measures Group reporting option (mainly because of the finite number of patients that can be easily measured).  Following is a link to 2013 PQRS Measures Codes, with related links and downloads at the bottom of the web page:  http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html

For more information on how Medical-Billing.com can assist in helping you avoid PQRS penalties, please contact us today at 800-966-9270.

Steve Elliot, COO – With over 32 years’ healthcare experience in various financial, corporate and administrative positions, Steve founded his   first medical billing company in 1992.  His expertise is in the implementation of practice management systems, development of middle    management infrastructure, and revamping the company’s billing model.  Steve also manages client development, financial and administrative   activities of the company.  He has a BBA from Georgia College and did his graduate studies at the University of South Carolina.
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