Medical Billing Blog

How to Avoid 2016 PQRS Payment Adjustment in 2014

Posted by Scott Shatzman on Tue, Jun, 10, 2014 @ 08:06 AM

miracles resized 600Individual eligible professionals (EPs) or those that are part of a group practice participating in PQRS must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment. CMS has produced a document entitled 2016 PQRS Payment Adjustment that explains how to avoid the payment adjustment.


As a review, EPs can avoid the 2016 payment adjustment by meeting one of the following criteria during the one-year (January 1–December 31) 2014 reporting period:

 

If the EP is participating as an Individual Eligible Professional:

 

  • Meet the criteria for satisfactory reporting adopted for the 2014 PQRS incentive.

OR

  • Participate in PQRS via qualified clinical data registry, qualified registry, or claims reporting and report at least three measures covering one National Quality Strategy (NQS) domain for at least 50 percent of the eligible professional’s Medicare Part B Fee-For-Service (FFS) patients.

 

If EP is participating as a member of a Group Practice:

 

  • Meet the Group Practice Reporting Option (GPRO) requirements for satisfactory reporting.

OR

  • Participate in PQRS via qualified registry reporting and report at least three measures covering one NQS domain for at least 50 percent of the group practice’s Medicare Part B FFS patients

 

If you need additional information, you are encouraged to visit the CMS PQRS Website

 

CMS has announced that EPs who wish to participate in the 2014 PQRS program as a group practice can now register for the group practice reporting option (GPRO).

 

Groups can access the Registration System and will need to use a valid IACS User ID and password to choose their reporting mechanism. The registration system will be open until September 30, 2014 for the 2014 PQRS program.


As a reminder, group practices participating in the GPRO that satisfactorily report data on PQRS measures during the 2014 reporting period (January 1- December 31) are eligible to earn a 0.5% incentive payment and will avoid the -2% 2016 PQRS payment adjustment.

 

Groups of physicians with 10 or more eligible professionals that want to participate in the PQRS as a group must register for a PQRS group reporting mechanism in the PV-PQRS Registration System (link above).  Please note that in order to avoid the -2% Value Modifier payment adjustment in 2016, the group must meet the criteria to avoid the 2016 PQRS negative payment adjustment.

 

Thanks to Bill Finerfrock, Matt Reiter, Lara Burt, Cassy Perkins and Carolyn Bounds for contributing the article.