PQRS

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Physician Quality Reporting System

The Physician Quality Reporting System (PQRS) is an incentive payment program for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries.

2013 PHYSICIAN QUALITY REPORTING SYSTEM Overview for Ophthalmic Practices

ASCRS/ASOA compiled the 2013 Physician Quality Reporting System Overview for Ophthalmic Practices to assist our members in understanding the PQRS program and provide a one-stop resource for eligible professionals (EPs). The Medicare PQRS program, is an incentive payment program for EPs who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries. Starting in 2015, EPs who do not participate in PQRS and successfully report during the 2013 reporting period, will be assessed a 1.5% reduction in all Medicare fee-for-service payments. We have summarized the program and provided links to the relevant CMS webpages. You may also go directly to the CMS PQRS Incentive Program website to obtain more information.
 
Contents:
1. Who Can Participate in PQRS?
2. Is Registration Required?
3. What Is the Financial Incentive for PQRS?
4. What is the Financial Penalty for Not Doing PQRS?
5. Reporting Methods
6. How To Receive The 2013 Incentive AND Avoid the 2015 Penalty
7. Ophthalmology Measures for 2013:
8. Informal Appeals Process
9. Feedback Reports
10. New for 2013
11. Resources
 

Outcome Ophthalmic Registry 

PQRS REGISTRY REPORTING FOR OPHTHALMOLOGY

Update:

Dear PQRS Participant,

The following will provide you with an overview of the PQRS requirements, Outcome Registry pricing structure and the process for getting started.  All of this information contained in this email is specific to ophthalmology practices. 

PQRS Reporting Requirements:

In order to meet the PQRS requirements for 2013, there are two options to obtain the 0.5% incentive payment.  If you are not interested in obtaining the incentive payment and just want to avoid the financial penalty, those requirements are outlined below as well.  Your options are as follows:

Cataract Measures Group:
 

  • The requirement for the Cataract Measures Group is for each provider to report 20 encounters, a majority of which have to be Medicare (the rest can be any other payer).  For each patient you report, you must distribute a pre-surgery and post-surgery survey for them to complete.  The pre-surgery survey needs to be given prior to their surgery.  You therefore will only be able to report those patients that you see from now until September 30th.  We have put together a detailed guide outlining the process for distributing these surveys.  Attached to this email you will find five documents relating to the Cataract Measures Group.  The first three are the surveys that need to be distributed.  The next two are an instruction guide detailing the process for distributing and returning the surveys as well as an FAQ.  If you intend to report the Cataract Measures Group, we highly recommend getting started on distributing these surveys immediately to make sure you meet the 20 encounter requirement. 
  • There are four measures within the Cataract Measures Group.  In order to successfully report this Measures Group, you have to report on all four measures.  Measures with a 0% performance will not be counted and you will not qualify for the incentive payment. 

Individual Measures:
 

  • For those providers who do not perform cataract surgeries, the other option is to report via Individual Measures.  There are nine Individual Measures that apply to eye care.  Each measure has a detailed Denominator that is outlined in the final document that is attached to this email.  The requirement is to report 80% of the Medicare encounters that apply to that Denominator criteria.  If you report via Individual Measures, you will need to report 80% of all encounters that were seen from January 1st, 2013 through December 31st, 2013.

Avoiding the Financial Penalty:
 

  • In order to avoid the financial penalty in 2015 (also referred to as the ‘payment adjustment’), you have two options.  You can either satisfactorily report Individual Measures or the Cataract Measures Group (requirements outlined above), or you can report a minimum of one patient for at least one individual measure.  You are allowed to have a 0% performance rate if you choose the second option. If you do not report any data for the 2013 reporting period, you will be subject to a 1.5% payment adjustment on your 2015 Medicare payments.  You can learn more about the payment adjustment here.

eRx:

  •  You also have the ability to obtain the eRx incentive payment through our Registry.  There is no additional cost for this option if you are also reporting PQRS data.  The requirement is to report any 25 Medicare encounters from January 1st through December 31st for each provider.  The data entry timeframe for your eRx data is the same for PQRS.  These timeframes are outlined below. 
  • Also, please note, if you are currently participating in Meaningful Use, you do not need to worry about reporting eRx as Meaningful Use already fulfills the eRx requirements.

Optometrists, Nurse Practitioners and Physician Assistants:
 

  • Any provider that bills Medicare under their NPI is eligible for the payment adjustment as well as the payment incentive.  Therefore, you will want to report for these providers as well if they bill Medicare under their NPI.  Most of these providers will need to report through the Individual Measure option, which is outlined above. 

Data Entry Process:
 

  • There are two ways you can enter your data into our Registry.  The first is a manual process which involves logging into our web-based Registry, pulling up an electronic form and manually typing your data into our forms.  The other option is the process of uploading data.  If your practice has an electronic billing system or practice management system that is capable of exporting data into a .csv file, you can format the file to our specifications and upload it into our Registry.  If you are interested in this option, our Help Desk can send you a specification manual which shows you exactly what data elements are captured and how to format your file to our specifications.  Uploading data can eliminate most, if not all, of the manual data entry.

Demo:

  • We will be conducting demo’s in the upcoming months as updates are made to our Registry.  The registration links for these webinars will be available on our website: http://www.outcome.com/pqrs.htm

Availability of 2013 Measures:

Cataract Measures Group:

  • Our Development Team is in the process of updating our Registry to meet the 2013 requirements.  CMS makes changes to the measures from year to year so we need to make sure we update everything accordingly.  In the meantime, we highly recommend you start distributing the patient surveys.  When our Registry is available for data entry, our Help Desk will contact you to get started.

Individual Measures & eRx:

  • The Individual Measure forms are being updated as well.  A communication will be sent out when these are available. 

Pricing:

We have two different pricing structures based on the different reporting options.  Both are annual fees and cover the submission of your 2013 data.  They are as follows:

  • Cataract Measures Group:          $717.43/provider
  • Individual Measures:                  $518.43/provider

Registration:

Agreements for 2013 are to be completed electronically.  Even if you have participated with Outcome in the past, you will need to complete the Agreement again for 2013.  Please use the following link to access the registration page:

http://www.outcome.com/aaoform.htm 

Please only submit the e-Agreement once.  You will receive a confirmation email once it has been successfully submitted.  When we have the 2013 forms available for data entry, our Help Desk will reach out to you to get you up and running.

Data Entry Timeline:

  • December 31st, 2013:                 Deadline for signing an e-Agreement with Outcome
  • January 31st, 2014:                      Data Entry Deadline
  • Mid-to-late Summer 2014:          Incentive Payments distributed
     

RESOURCES:

Outcome® PQRS Registry: Patient Survey Instructions for the Cataracts Measure Group

FAQs

2013 PQRS Options for Individual Measures

Pre-Surgery Visual Functioning VF-8R Patient Questionnaire

Post-Surgery Visual Functioning VF-8R Patient Questionnaire

CAHPS® Surgical Care Survey

If you have any questions on this information, please do not hesitate to let us know.  

 

 

2013 PQRS Program Overview

The Physician Quality Reporting System (PQRS) is an incentive payment program for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries.

Who Can Participate in PQRS?

National Provider Call on 2014 eRx and 2015 PQRS Payment Adjustments - June 18, 2013, 1:30-3:00 p.m. EDT

On June 18, 2013 from 1:30-3:00 p.m. ET CMS will host a call to provide a general overview on the Physician Quality Reporting System (PQRS) payment adjustment and the Electronic Prescribing (eRx) Incentive Program payment adjustment, as well as specifics on the 2015 PQRS and 2014 eRx adjustments, including eligibility, how to avoid future payment adjustments, key points, and tips for successful participation. The presentation will also offer a list of resources and contacts for additional support. A question and answer session will follow the presentation.

Updated Information on 2013 PQRS Reporting via Outcome Registry Now Available

 

On Wednesday May 29, Outcome™ PQRS Registry, a CMS qualified registry sponsored by the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO), released updated information for 2013 PQRS/eRx submission.

 

The following will provide you with an overview of the PQRS requirements, pricing structure, and the process for getting started. All of the information contained in this email is specific to ophthalmology practices.

 

PQRS Reporting Requirements:

Getting Started with Physician Quality Reporting System (PQRS) Reporting: Implications for the Value-based Payment Modifier—Wednesday, June 5; 1:30–2:30 pm ET

 

This call will cover how to obtain an Individuals Authorized Access to the CMS Computer Services (IACS) account for (1) physician group practices to select their CY 2013 PQRS Group Reporting Mechanism, and if applicable, elect quality tiering to calculate their CY 2015 Value-based Payment Modifier; and (2) individual eligible professionals to select the Administrative Claims reporting mechanism for CY 2013. A question and answer session will follow the presentation.

CMS Webinar on EHR Incentive Programs, PQRS, and eRx—Multiple Sessions Available

CMS will be offering the webinar "CMS 2013 Medicare Incentives Programs" in multiple sessions throughout the next month. The webinar will cover the EHR Incentive Programs, Physician Quality Reporting System (PQRS), and the eRx Incentive Program, including eligibility, key program milestones, payment adjustments, and hardship exemptions.

You may register for one of these calls by clicking the links below. The dial-in number and link to the webinar will be given upon registration.