PQRS: It Doesn’t Have to be Painful

There are a few topics that consistently return the most questions in my Continuing Education classes, and one of them is PQRS (Physician Quality Reporting System).  Mainly, why do we have to do this and why are they reducing my Medicare payments if I do not?

What is PQRS?

The Physician Quality Reporting System (PQRS) is a voluntary Centers for Medicare & Medicaid (CMS) program, with the stated purpose of “encouraging health care professionals and group practices to report information on health care practices.” Their goal through this is to lead to better care for Medicare patients.

As a provider, you participate either through Individual or Group Measures. There are hundreds of available measures (download from CMS as an Excel spreadsheet here), and you can chose applicable measures for your office. One of the most widely applicable measures is Medication Documented (Measure #130). There are also measures for Pain Assessment and Follow Up (Measure #131), Functional Outcome Assessments (Measure #182), and many more.

Why Participate?

CMS hopes that participating in these quality measures will lead to better patient care, and more informed care for the patient. On top of that, as an added “incentive” to participate, CMS imposed a 2% fee schedule reduction for providers who do not participate in the program. If you do not participate, you likely already see this on your Medicare Remittance Advices:

“CO-237 – LEGISLATED/REGULATORY PENALTY”

“N699 – PAYMENT ADJUSTED BASED ON THE PHYSICIAN QUALITY REPORTING SYSTEM (PQRS)”

If your Medicare patient volume is high enough, it could cause a noticeable decrease in reimbursement. It is a technically voluntary program, so you can decide whether or not your practice should participate based on the administrative load it would require and the decrease in payments you face for not participating.

How to Participate?

Many Electronic Health Record (EHR) programs compile the PQRS relevant information from the patient’s chart and send on for you. This is the most efficient way to participate, and should take the least administrative time for the office. They may also suggest some measures you did not realize your practice would be eligible to report.

If you are not using a full EHR program or if your EHR system does not have PQRS capability, you can report the measures on claims. The measures can be reported using dedicated “G” codes. Each applicable “G” code is added as a line item to your claims. These codes hold no value with Medicare and no reimbursement for them will be made.

Another option is to use a PQRS program. There are many PQRS alternatives to EHR that you can purchase. You must enter all of the information into their system, but they compile it for you and send it on to CMS on your behalf. They can also identify deficiencies and suggest new measures if applicable.

How Many Measures?

CMS suggests each practice report 9 individual measures.  If there are not 9 applicable measures to your practice you can, however, still avoid the reduction. A good example of this is with Chiropractic practices. Reporting on 2-3 measures for a Chiropractic office is usually enough to avoid your 2% reduction in fee schedule.

 

If any of our clients need PQRS guidance, email info@inchargeoffice.com to find out if you’re already reporting or how to get started.

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