With the new year upon us, physicians who didn’t report PQRS measures in 2013 will soon be hit with penalties. If you’re one of them, don’t fret, CureMD has you covered.

Let’s take a quick look at PQRS’ backstory before we dive into how it’s going to affect your practice from here on out and how CureMD can help you report and avoid future penalties.

The Little Reporting System that Could

PQRS stands for the Physician Quality Reporting System. Starting in 2007, as a voluntary program, PQRS offered incentives to healthcare providers who reported quality measures. However, the incentives proved to be insufficient in encouraging enough physicians to go through the trouble of collecting and reporting data.

Realizing that the stick works better than the carrot, CMS concluded that in order for their reporting system to do what it was intended to do, they were going to have to start penalizing physicians who were not participating.

 A Shift Toward Fee-for-Performance

PQRS and other reporting programs were meant to improve patient care and overall efficiency. Historically, the healthcare industry has been a fee-for-service model, reimbursing providers for each service delivered. Procedure and treatment codes were based solely on time spent with the patient, not whether that time was spent well or if the patient was given proper care and treatment.

To rectify this, Medicare needed to collect qualitative as well as quantitative data on the state of the healthcare industry, and that is why PQRS was launched.

Reporting Methods

Eligible physicians are able to earn PQRS incentives through the Electronic Health Record (EHR) based reporting method. In accordance with the newly-established standards by the Office of the National Coordinator for Health Information Technology (ONC), EHR systems must be Certified EHR Technology (CEHRT). Quality measures can be submitted directly from the CEHRT or extracted first and then submitted to an EHR data submission vendor.

In 2010, CMS created a new PQRS reporting option for group practices (GPRO). In this option, incentive payments are equal to a specific percentage of the group’s total estimated Medicare Part B Fee Schedule. Eligible groups may report their quality measures through a web interface (for groups of 25 practitioners or more), CEHRT, a CEHRT data submission vendor, or CAHPS via a CMS-certified survey vendor (also for groups of 25 members or more).

If your practice didn’t report PQRS in 2013, you are about to get hit with a 1.5% penalty. And, to add insult to injury, if your organization has more than 20 providers, you might also face the Value Based Payment Modifier, which would deduct an extra 2% from all of your Medicare Part B reimbursements.

Moreover, although your practice has to meet certain CMS criteria, you do not need to sign up or register for participation in the program. The only agency you may have is that groups may self-nominate in order to submit as a group instead of an individual.

Besides the main reporting methods mentioned above, there are more than 6 domains through which you can report more than 250 quality measures. These address areas such as procedure-related care, preventative care, and care coordination. The measures you select would depend on the size of your practice, your specialty, your EMR reporting ability, and your personal participation in the Meaningful Use Program.

What Now?

Although it seems like we’ve painted a rather grim picture, there is a silver lining to this PQRS cloud. If you reported PQRS requirements in 2013 but have still been served a notice for penalties, CureMD can help in making the appeal to CMS on your behalf. We can also provide assistance with any penalties you may have incurred.

The window for 2014 reporting does not close until February 28^th, 2015, and we can help you report accurately for this past year so that you are not hit with any further penalties in 2016. CureMD will continue to help you with reporting to save further penalties (which will increase) in 2017.

If PQRS penalties is what is ailing you, then we have the cure. Get in touch with us today. Call our PQRS consultant on 718-213-4870 or send us an email at consultants@curemd.com.