I just had the pleasure of co-presenting a webinar with Nancy Beckley called Medicare Made Simple. Our goals in the webinar were to review basic Medicare requirements and to offer our listeners some practical background information and resources that they could use in their practice. We also invited our listeners to send us a note if they had any questions. Nancy and I were both astounded at the number of questions and the amount of confusion that still exists about the PQRS program. The PQRS program isn’t new, but it is obvious that the visit eligibility requirements and the successful participation requirements are both very confusing. This is a brief summary of those requirements:
Visit Eligibility
Whether or not a visit is eligible for PQRS reporting always depends upon the patient’s age and the other procedures performed during the visit. Some PQRS measures also have diagnosis code requirements. Since PTs, OTs, and Speech Pathologists only use a subset of procedure codes, there are a limited number of PQRS measures that they may utilize. Here are some examples:
- You may report on the Medication List Measure if the patient is 18 years old or older and you have completed any of the following procedures during the visit: 97001, 97002, 97003, 97004, 97110, 97140, 97532, among others.
- You may report on the Pain Assessment Measure if the patient is 18 years old or older and you have completed any of the following procedures during the visit: 97001, 97002, 97003, 97004, 97532, among others.
Successful Participation
To avoid a payment reduction of 2%, which will be imposed in 2016, for your participation in 2014: Report on 3 or more measures on at least 50% of the visits where the measure was eligible for reporting. To gain a bonus payment, which will be disbursed in 2015: Report on all of the available measures on at least 50% of the visits where the measure was eligible for reporting.
Other Factors
The above information only pertains to claims based reporting, meaning that these PQRS quality measure codes (G Codes) are reporting on the claims for your visits. Claims based reporting can be done at no additional cost. Registry based reporting is typically done from an EMR reporting directly to your Medicare contractor outside of the claims process. There are more codes eligible for registry based reporting, but there is usually an extra fee for registry reporting as well.
Making It Easier
At Clinicient, we currently support claims based reporting. We will let your therapists know, automatically, all of the applicable PQRS measures for the visit. All the therapist needs to do to report the measures is check on which measures were completed. This is free with our service – we do not charge additional fees for submission. To learn more about how Clinicient can help your practice manage PQRS, download our datasheet. Then, watch our complimentary on-demand webinar with compliance expert Nancy Beckley.
