How to earn PQRS bonuses in 2014

Earning Medicare Physician Quality Report System (PQRS) payment bonuses will require more effort in 2014.

You must report on PQRS measures for 50 percent of your applicable patients

Most practitioners will be required to report on nine quality measures—up from just three in past years. To ensure successful PQRS participation—especially with new, more complex rules—the AOA Advocacy Group recommends using online resources offered by the AOA.

If you meet PQRS requirements during 2014, you will earn a payment bonus equaling 0.5 percent of Medicare allowed charges for the year. If you do not participate during 2014, you will find your Medicare reimbursements reduced 2 percent during 2016.

Report on all measures that apply

If fewer than nine PQRS measures apply to your practice, you can still earn a bonus by reporting on all measures that do apply.

You will be subject to a Measures Applicability Validation (MAV) process. Through this process, the U.S. Centers for Medicare & Medicaid Services (CMS) will determine whether you should have reported quality data codes for additional measures.

The reported measures must cover at least three of the federal National Quality Strategy (NQS) domains established by the U.S. Department of Health & Human Services (HHS). These include:

  • Effective clinical care
  • Communication and care coordination
  • Patient safety
  • Community/population health

Measures for optometry

The CMS never officially indicated which PQRS quality measures apply to optometry.

However, the center has identified at least 14 measures, including seven specific to eye care, that appear appropriate for reporting by an optometrist.

"If an optometrist reports on the seven eye care measures and selects two of the 'extra' measures to report—bringing the total to nine measures reported—the optometrist has the potential to earn a bonus and avoid the penalties that will be applied under the PQRS in future years," says Rebecca Wartman, O.D., of the AOA Third Party Center Executive Committee.

To earn bonuses, you must report on PQRS measures for 50 percent of your applicable patients.

"Optometrists will again be able to report quality measures for patients with age-related macular degeneration (AMD), diabetes, and glaucoma," Dr. Wartman notes. "Optometrists can also again report on quality measures applicable to their general patient base, such as documentation of current medications and screening for tobacco use."

PQRS Feedback Reports for 2012 suggest ODs should report no fewer than eight measures.

February 6, 2014

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