The Centers for Medicare and Medicaid Services (CMS) has developed the statutorily required quality reporting initiative for physicians and other providers. The initiative consists of quality measures that physicians can report to be eligible for a bonus.
The measures are available on the CMS Web site. In an effort to help our members better understand the Physician Quality Reporting System (PQRS), the AOA has put together the following questions and answers:
What is the Physician Quality Reporting System?
On Dec. 20, 2006, President Bush signed into law the "Tax Relief and Health Care Act of 2006" (PL 109-432). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI). As of 2011, the program is titled Physician Quality Reporting System.
Is PQRS voluntary?
Yes. While CMS is required by law to establish the program, physicians are not required to participate in the program. However, physicians who do participate are eligible for a bonus payment, subject to a cap, of 0.5% of total allowed charges for covered Medicare physician fee schedule services. After 2011, this percentage will begin to decrease.
When does the program begin? End?
PQRS has entered its sixth year. The reporting period for 2012 is Jan. 1- Dec. 31, 2012. Eligible professionals report on a designated set of quality measures for services provided between these dates. You may submit data to CAP PQRS until Feb. 1, 2013, 5 p.m. EST. In order to participate in CAP PQRS go to www.osteopathic.org/pqrs.
What measures will be used for PQRS?
CMS has expanded the number of measure groups to 22. Greatly expanding your opportunity to participate in the program, the AOA CAP PQRS will offer all 22:
Asthma
Back Pain
Cardiovascular Prevention
Cataracts
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Community Acquired Pneumonia
Coronary Artery Bypass Graft
Coronary Artery Disease
Dementia
Diabetes Mellitus
Heart Failure
Hepatitis C
HIV/AIDS
Hypertension
Inflammatory Bowel Disease
Ischemic Vascular Disease
Parkinson’s Disease
Perioperative Care
Preventive Care
Rheumatoid Arthritis
Sleep Apnea
In addition to the measure group option, we are offering the individual measure reporting option. There are 21 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. The 21 measure sets include:
Allergy and Immunology
Chest Medicine
Chiropractic
Critical Care
Dermatology
General
Hematology/Oncology
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics/Gynecology
Ocular
Oncology
Optometry
Orthopedic
Otolaryngology
Plastic Surgery
Radiation Oncology
Radiology
Surgery
Urology
What do I have to do to participate?
You will need to select your measures, complete registration and then enter your chart data from your Medicare Part B patients. You will be presented with a series of questions for each patient. It only takes a few minutes to enter each patient. The AOA CAP for PQRS will submit your completed report to CMS on your behalf.
If I participate in more than one multiple measure group, or report more than three individual measures, will I increase my incentive payment?
No. CMS is offering a maximum incentive of 0.5% of your total allowed Medicare charges for Physician Fee Schedule (PFS)-covered services.
How many patients do I need to report? Does it matter which ones I choose?
There are different requirements for reporting on Measure Groups versus Individual Measures. For Measure Groups reporting, CMS requires that you report on 30 Medicare Part B Fee-For-Service (FFS) patients who are eligible for the Measure Group, or 80% of your Medicare FFS patients with a minimum sample of 15 patients. For Individual Measure reporting, you must report on 80% of your Medicare Part B FFS patients who are eligible for a minimum of three individual measures. All patients reported must have been seen during the 2012 calendar year.
Currently is there a fee to participate in the CAP PQRS?
Yes. There is a $199 fee for AOA members and a $299 fee for non-members. We also have special pricing for nurse practitioners, physician assistants, certified nurse specialists and registered dieticians, as well as for group practices of 10 or more physicians. Please call Angi Beranek at (800) 621-1773, ext. 8198 or (312) 202-8198 for details about pricing.
Will I be audited?
CMS requires that each registry perform a validation of the data submitted. You may be selected to submit a few of your charts for a reabstraction. Make sure to keep track of the 30 charts you select for submission and track them with their Patient Identifier. This is the approximately eight-digit number that the computer automatically generates for each entry. Please contact Angi Beranek at (800) 621-1773, ext. 8198 if you have any questions.
Does a physician have to enroll in the program in order to participate?
No. A physician can participate by reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor.
I have entered all of my data and submitted my PQRS report through PQRIwizard. When will I get my incentive payment?
CMS has not provided specific information as to when the 2012 incentives will be paid. However, based on previous years, it’s likely that the 2012 incentive will be paid by the fall of 2013. For more information about your incentive payment, contact the CMS PQRS Help Desk.
How will my incentive be paid?
If you currently receive your claim payments from Medicare electronically, then your PQRS incentive payment will be paid electronically to the same account. (For 2009, such payments were documented on your Medicare electronic remittance advice with a code of PQ09 and the indicator LE.)
If you currently receive your claim payments from Medicare on a paper check, then your PQRS incentive payment will also be paid by paper check. That check will be mailed to the address associated with the Tax ID Number and NPI in the National Plan and Provider Enumeration System (NPPES) system. If that address is incorrect or has been changed, you will need to update the address with NPPES (https://nppes.cms.hhs.gov).
Can a bonus payment be denied?
Yes. While the physician determines which measures to use, CMS will validate (i.e., through sampling) whether the applicable measures have been reported. The agency's determinations are excluded from formal administrative or judicial review. The agency will establish an informal inquiry process.
If I have questions about CAP PQRS, whom should I contact?
If you have questions, you should contact Angi Beranek, MPA, Manager, Division of Clinical Quality. Phone: (800) 621-1773 ext. 8198; email: aberanek@osteopathic.org.