2014 Rules for PQRS

CMS issued Final 2014 Physician Fee Schedule Rule on November 27, 2013.

Summary of Changes:

• 2014 PQRS measures group reporting  can only be done with a registry.
• It could be easier for a provider to report 2014 PQRS with a registry instead of using claims because a provider only needs to report 20 patients with a measures group and also some measure groups have less than 9 measures.
• 2014 PQRS bonus is 0.5% of the total estimated Medicare Part B allowed charges
• 2014 individual PQRS measures reporting: report at least 9 measures, OR, if less than 9 measures apply to the eligible professional, report 1—8 measures, AND report each measure for at least 50 percent of the eligible professional’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. For an eligible professional who reports fewer than 9 measures via the claims-based reporting mechanism, the eligible professional would be subject to theMeasures Applicability Validation (MAV) process, which would allow CMS to determine whether an eligible professional should have reported quality data codes for additional measures. The 9 measures need to cover at least 3 NQF domains: Patient Safety; Person and Caregiver-Centered Experience and Outcomes; Communication and Care Coordination; Effective Clinical Care; Community/Population Health; Efficiency and Cost Reduction
• Final Individual Quality Measures and Those Included in Measures Groups for the Physician Quality Reporting System to be Available for Satisfactory Reporting via Claims, Registry, or EHR Beginning in 2014
• Measures To Be Removed from Reporting in the Physician Quality Reporting System in 2014
• PQRS GPRO measures collected through the GPRO web interface during 2012 will be publicly reported on Physician Compare in 2014
• 2014 GPRO PQRS: report at least 9 measures covering at least 3 of the NQS domains, OR, if less than 9 measures covering at least 3 NQS domains apply to the group practice, report 1—8 measures covering 1-3 NQS domains for which there is Medicare patient data, AND report each measure for at least 50 percent of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. For a group practice who reports fewer than 9 measures covering less than 3 NQS domains via the registry-based reporting mechanism, the group practice would be subject to the MAV process, which would allow CMS to determine whether a group practice should have reported on additional measures and/or measures covering additional NQS domains.
• CMS will publicly report some 2014 PQRS individual measure data in 2015 if technically feasible.
• 2014 PQRS GPRO self-nomination deadline is September 30, 2014
• Group practices of 25-99 eligible professionals that would like to report the CG CAHPS survey measures need to use a CMS-certified survey vendor.
• 2014 value-based payment modifier policies:
• To apply the value-based payment modifier to groups of physicians with 10 or more eligible professionals in CY 2016.
• To increase the amount of payment at risk under the value-based payment modifier from 1.0 percent to 2.0 percent in CY 2016.
• To make quality-tiering mandatory for groups within Category 1 for the CY 2016 value-based payment modifier, except that groups of physicians with between 10 and 99 eligible professionals would be subject only to any upward or neutral adjustment determined under the quality-tiering methodology, and groups of physicians with 100 or more eligible professionals would be subject to upward, neutral, or downward adjustments determined under the quality-tiering methodology.
• CMS National Provider Call: The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule
• Register now for the December 17, 1.30pm Medicare National Provider Call: 2014 Physician Fee Schedule Final Rule: Quality Reporting in 2014. The call will provide an overview of the 2014 Physician Fee Schedule (PFS) Final Rule. This presentation covers program updates to the Physician Quality Reporting System (PQRS). In particular, this call includes details on how an eligible professional (EP) or group practice can meet the criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment. In lieu of satisfactory reporting, the call also covers how to meet the criteria for satisfactory participation under the new qualified clinical data registry option, which will be implemented in 2014 as a result of the American Taxpayer Relief Act of 2012. In addition to the PQRS, this presentation contains additional program updates to the Electronic Health Record (EHR) Incentive Program and Physician Compare. A question and answer session follows the presentation.