5 takeaways for PQRS in 2016

5 takeaways for PQRS in 2016

AOA is helping members start the New Year on the right foot with a comprehensive look at the nuances of the 2016 Physician Quality Reporting System (PQRS) and how to avoid future penalties.

Webinar will provide doctors and staff with information needed to avoid future penalties.

Like last year, there are no bonuses for doctors' successful PQRS participation, but there remains incentive. Satisfactory PQRS participation in 2016 is vital because it prevents a 2 percent loss in doctors' total Medicare payments in 2018.

The Centers for Medicare & Medicaid Services (CMS) notes this 2018 PQRS payment adjustment will be the last adjustment issued under PQRS as the new Merit-Based Incentive Payment System (MIPS) will then take effect, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

To aid in successful PQRS participation, Rebecca Wartman, O.D., AOA Third Party Center committee member and AOA Coding Expert, offers five tips and reminders to help doctors in 2016:

  1. Use only one diagnosis for any PQRS measure, even though more than one diagnosis on a claim may be applicable;

  2. Be aware that doctors' decision to participate in PQRS has a greater impact on their reimbursement because lack of PQRS participation is linked to the Value-based Modifier (VBM) and could result in a 4 percent reduction in Medicare reimbursement;

  3. Report at least nine PQRS measures in 2016 to avoid a PQRS penalty and an additional VBM reduction;

  4. Pay attention to the proper diagnosis code linked to any measures as well as other factors, such as age and examination codes; and,

  5. Doctors should not file PQRS codes if they do not have an E&M code or a General Ophthalmological Code. If doctors are only performing a procedure, do not use PQRS codes.

In 2016, a 2 percent PQRS negative payment adjustment will be assessed on doctors who did not meet the criteria for satisfactorily reporting in the 2014 PQRS. Doctors should also be aware that CMS extended the 2014 informal review period for doctors and practices suspecting they have been incorrectly assessed with the 2016 PQRS penalty to 11:59 p.m. EST, Dec. 16, 2015.

AOA has heard from members who received notice from CMS about the penalty, and recommends doctors who tried to report measures for PQRS obtain their 2014 PQRS Feedback Reports to determine what might have gone wrong. For future deadlines and milestones related to PQRS, members should review the 2015-2017 PQRS Timeline.

December 10, 2015

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