Don’t lose in 2015

Don’t lose in 2015

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D. From the March 2015 edition of AOA Focus, page 50.

If you opt not to participate in the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) for 2015, you will lose 2 percent of your total Medicare payments in 2017.

When you choose not to participate in PQRS, you lose 2 percent of your Medicare payments.

Due to 2013 sequestration, all Medicare payments, including meaningful use payments, have been reduced by 2 percent. If you have chosen not to participate in the meaningful use program, you are losing another 2 percent (unless you qualify for an exemption). When you choose not to participate in PQRS, you lose yet another 2 percent of your Medicare payments. These reductions add up to a total of 6 percent lost to your practice. For many providers, 6 percent begins to have a real financial impact.

In 2014, the PQRS program introduced some real changes. The number of measures required to successfully report increased from 3 to 9. Providers were required to properly report at least 9 measures for at least 50 percent of the claims where the measures applied. Successful PQRS participation also required the provider to report on measures in at least 3 of the 6 National Quality Strategy (NQS) Domains. Those domains encompass patient safety, person and caregiver-centered experience and outcomes, communication and care coordination, effective clinical care, community/population health and efficiency, and cost reduction.

The 2015 PQRS program is presenting a bit more of a challenge. One of the longstanding PQRS measures used by optometry was eliminated from claims-based reporting. The deleted measure is Measure 18, Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (NQS domain: effective clinical care). This measure can only be reported with the electronic health record method of reporting and could well be eliminated altogether in 2016.

The other six eye care specific measures for glaucoma, macular degeneration and diabetes were left intact for 2015 reporting using claims-based reporting. There are three other measures that can be reported by optometry for 2015. Those measures are: Measure 130, Documentation of Current Medications in the Medical Record (NQS domain: patient safety); Measure 226, Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (NQS domain: community/population health); and Measure 317, Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented (NQS domain: community/population health). All of these measures are linked to the General Ophthalmologic Codes (92002-92014) and the Evaluation and Management Codes (99201-99215).

Other measures could be used by optometry; however, these other measures are not linked to the General Ophthalmologic Codes (92002-92014) and may not be the most applicable PQRS measure choices.

There are several ways to report PQRS measures. Optometrists have traditionally used the claims-based reporting option. The other reporting methods include group reporting, registry reporting, measures group reporting, electronic health record reporting and meaningful use reporting, through a Certified Survey Vendor.

The moral of the story: Do not lose up to 6 percent of your Medicare income simply because you do not take the time to participate in this important program.

March 24, 2015

comments powered by Disqus