How to comply with PQRS requirements in 2015
Changes are coming for the Physician Quality Reporting System (PQRS). Participation in 2015 means avoiding a 2-percent cut to your Medicare payments in 2017.
"The biggest errors in the past have been using measures that do not apply to a specific patient."
Additionally, in 2015 bonuses will no longer be given for successful participation.
Many optometrists have taken part in the program; as of 2012, at least 32 percent of eligible ODs were participants, according to data from the Centers for Medicare & Medicaid Services.
There's a downside to nonparticipation. On Nov. 10, CMS sent letters to ODs and other doctors who did not participate in PQRS in 2013, informing them they would be subject to a 1.5 percent payment penalty in 2015.
AOA informed members earlier this year of the steps they should take in 2014 to earn PQRS bonuses and avoid penalties in 2016.
PQRS changes that affect ODs
The AOA wants ODs to be aware of coming changes to PQRS in 2015. Previously, eligible providers could earn a bonus for successfully reporting on PQRS measures. No such bonus exists next year.
However, ODs who participate will prevent a 2-percent loss from their total Medicare payments in 2017, Rebecca Wartman, O.D., a member of the AOA Third Party Center Coding Committee, notes.
Most ODs use claims-based reporting to participate in PQRS quality reporting. For 2015, AOA successfully protected the claims-based reporting option for many measures that ODs report.
One measure has been discontinued for 2015: "Diabetic Retinopathy: presence or absence of macular edema and level of retinopathy." This means that ODs have nine instead of 10 available quality measures to do their reporting.
Six eye-care-specific measures can still be filed, Dr. Wartman says. There are also three "cross cutting" measures available to ODs: tobacco use and counseling, hypertension and follow up, and medication listing.
To avoid the 2-percent penalty in 2015, ODs must:
- Report accurately on nine measures for applicable patients 50 percent of the time.
- Report on at least one quality measure from the "cross cutting" measure set. It is important to note that the cross cutting measure counts toward the nine total required measures.
If fewer than nine measures apply, eligible providers can still participate.
ODs should be aware that reporting fewer than nine measures would trigger the Measure-Applicability Validation (MAV) review. CMS conducts this review to determine whether a physician should have reported additional measures (read more on page 51 of the November/December 2014 edition of AOA Focus). CMS has resources available that describe the MAV, and intends to release additional guidance in the future.
ODs need to be consistent in their reporting, Dr. Wartman advises. "The biggest errors in the past have been using measures that do not apply to a specific patient either due to diagnosis used, or age or other factors," she says.
To get the most out of participation, the 2014 PQRS Summary Chart (member login required) is available at no cost to members. This summary chart includes the PQRS codes relevant to eye care practice—helpful information that will help practitioners earn bonuses and avoid penalties.
CMS will be holding a webinar on PQRS and other Medicare quality reporting programs on Tuesday, Nov. 25. Register now to secure your spot in this meeting.