Physician Quality Reporting System (PQRS) required this year to avoid penalties in 2015
Physician Quality Reporting System (PQRS) required this year to avoid penalties in 2015
Rebecca H. Wartman OD
The Physician Quality Reporting System (PQRS-formerly PQRI) has been in existence since 2007. While there are only a few minor edits to the program for 2013, it is an important year. If a provider (that means you) does not participate in 2013, you will be penalized in 2015. (See PQRS reporting required in 2013 to avoid 2015 payment cuts. Successful reporting means recognition for providing quality care for the individual doctor and for the Optometric profession, as well as more dollars in the coffers of the optometrist and avoidance of the 2015 penalties.
The PQRS bonus for 2013 will be 0.5 percent of your individual Medicare allowable on all claims filed in 2013. This includes all claims even those claims where the addition of PQRS measures were not appropriate. The success level for claims-based reporting is again reporting at least three different PQRS measures on at least 50 percent of the claims where the proper diagnosis and procedure codes are filed. This does not mean that a provider has to file three PQRS measures on 50 percent of your Medicare claims. The provider needs to choose at least three different PQRS codes to report for 2013 and then report these PQRS codes consistently on at least 50 percent of the appropriate claims filed.
While there are 241 PQRS measures for 2013, optometry need only be concerned with seven of these measures even though we could report on several more. An easy way to participate successfully in PQRS is to only consider glaucoma, diabetes and macular degeneration diagnoses.
There are two changes of note in the seven PQRS measures for diseases commonly seen in an optometry practice. The main change is the diagnosis codes allowed for the two glaucoma measures. Codes 365.70 to 365.74 were eliminated for measure #12 and #141. The other change is the assumption that if a patient with macular degeneration is already on AREDS antioxidant supplements, the provider has already discussed the pros and cons of these supplements for that particular patient (measure #140).
The Electronic health records measure 124 was retired in 2013 since Meaningful Use is well under way making this measure obsolete.
Electronic prescribing remains a stand-alone initiative. The guidelines for this initiative have not changed for 2013. Optometrists remain exempt from any penalty for not using electronic prescribing through 2014 when this initiative is scheduled to end. Keep in mind that electronic prescribing is a part of Meaningful Use. The final change that is of note would be the addition of the applicable ICD-10-CM diagnosis codes to the listing of applicable diagnosis codes. This was done to aid the provider to prepare for the October 1, 2014 mandatory transition from ICD-9-CM to ICD-10-CM.
AOAExcel has all the information and particulars for successful participation in PQRS 2013.
Important Links: Center for Medicare and Medicaid Services: