2014 PQRS

CMSThroughout 2013 medical providers were encouraged by the Center for Medicare and Medicaid Services (CMS) to report back what they determined to be “quality measures” to ensure eligible medical providers were providing “quality care” to their patients. Through 2013, providers were required to report back at least 3 measures derived from the PQRS manual provided by CMS, on at least 50 percent of their Medicare Part B and Railroad Medicare patients to avoid a 1.5 – 2 percent reduction to their Medicare Physician payments.

Starting in 2014, CMS released that they will now require eligible health professionals to report back 9 measures, across 3 National Quality Strategy Domains in order to qualify for the .05 percent increase. The Domains are what the National Quality Strategy research division of the Health & Human Services (HHS) identified as areas of healthcare that require “improvement”. Reporting options for PQRS measures have also changed. In 2013 providers were able to choose from four options to report back PQRS measures.

  1. At the Claim level on Part B Claims
  2. Any qualified PQRS registry
  3. Through EMR/EHR product
  4. valid PQRS data submission vendor

In 2014, reporting methods for PQRS measures depend upon which measure is being reported. As you can see in the example below, Heart Failure can not be reported on the claim level or through a Web Interface.

Example:

Measure                                                                               Reporting Option

Diabetes: Hemoglobin A1c Poor Control                        Claims, Registry, EHR, Web Interface

Heart Failure                                                                        Registry, EHR, Measures group

 

The same incentives and penalties from 2013 still apply in 2014, providers are just required to report more to qualify for the incentive increase. If you report 9 measures, across 3 domains on 50% or more, you receive a .05 percent increase in payments. If less than 50 percent is reported on at least 3 measures then a 1.5 to 2 percent reduction in payments will be applied to the individual provider. All requirements are based at the individual provider level not at the group/entity.

For more information on the 2014 PQRS requirements, and for a copy of the 2014 PQRS manual, visit http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html