American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

CAP for PQRS

 

 2013 CAP for PQRS Closed

 

The AOA CAP for PQRS 2013 program is now closed. The 2014 AOA CAP for PQRS will open in early summer.

 

 2013 CAP for PQRS

 

2013 PQRS Changes

  1. You only need to report on 20 patients from visit dates ranging between  Jan. 1, 2013- Dec. 31, 2013.

  2. Only 11 out of the 20 patients must be Medicare Part B patients. The other nine patients may be any other payer.

  3. You must use your individual national provider identifier (NPI) for the AOA CAP for PQRS program. Failure to use your correct NPI or tax identification number (TIN) will prohibit you from receiving a bonus incentive and you will also face a 1.5% penalty in 2015.

Should You Participate in the AOA CAP for PQRS?

Before you enroll in the AOA CAP for PQRS, consider these questions:

  • Are you part of an Accountable Care Organization (ACO)?  

If so, you will not be able to report PQRS using a registry. Please contact your ACO representative for more information.   

  • Is your billing department already reporting PQRS data on your behalf?

If so, you don't need to participate in CAP for PQRS; you've already fulfilled the PQRS reporting requirement, so there's no need to submit your data a second time.

  • Do you have an electronic health record (EHR) system?

If you do, find out whether your EHR system can submit PQRS data for you. If it can and you decide to use this functionality, you don't need to participate in the CAP for PQRS.

  • Is there a connection between the PQRS and the CMS Electronic Health Record (EHR) Incentive Program?

    • The 2013 PQRS is totally separate from the EHR Incentive Program, which evaluates whether you're meeting criteria for Meaningful Use of EHRs.

    • This means you can earn both the Medicare EHR Incentive Program incentive and the PQRS incentive if you meet both programs' criteria.

    • However, make sure to check with your EHR vendor to confirm they are reporting your PQRS data to CMS.

How to Participate in the AOA CAP for PQRS

You will need a few things to get started:

  • Your AOA ID and password to log in.

  • Your individual, personal national provider identifier (NPI) and your tax identification number (TIN) that you use when you bill Medicare.

  • Credit card for payment.

CAP Participation

The AOA developed the CAP for PQRS to provide physicians with an opportunity to receive enhanced payment from CMS and understand how patients are doing using evidence-based process and outcome measures. 

Eligible professionals can only choose to participate in one measure group per reporting year, and there is only potential to receive one bonus incentive per reporting year. CMS has expanded the number of measure groups to 22, which greatly expands your opportunity to participate in the program. The AOA CAP for PQRS offers all 22. Please note that there are changes and updates to some of the measure groups this year. 

In addition to the measure group option, we are offering the individual measure reporting option. There are 27 measure sets from which to choose. You must select at least three measures from one measure set and report 80% of your Medicare Part B patients that meet each of the three measures.

Requirements and Deadlines

  • CMS requires all registries to conduct audits of participant data.

  • Please make sure that you keep track of your patient charts and match them with their computer-generated Patient Identifier numbers. This is the approximately eight-digit number that is automatically populated in the system when you add a new patient to the program.

  • We suggest you keep a list in an Excel file for easy access and also record this number in the patient chart.

  • All data during the reporting period for 2013 must have been submitted by Jan. 31, 2014, 5 p.m. EST, to be eligible for the PQRS bonus payment.

  •  CMS payments for PQRS 2013 will be made in the fall of 2014.

  • The AOA CAP for PQRS reserves the right to accept or decline any request for a refund. If you feel that a refund is due, please contact AOA CAP for PQRS at aberanek@osteopathic.org prior to Jan. 31, 2014, at 5 p.m. EST. Include the following information: your name, an email address you would like the confirmation sent to, and reason for refund. A confirmation email will be sent with information related to your refund, including whether such a refund has been approved. The amount to be refunded in the case where the refund has been approved will incur a $25 processing fee.