PQRS Solutions for Physicians’ Practices

PQRS for Physicians Groups

When you figure the total payment Medicare adjustments your practice or group will receive via PQRS, as the system evolves with rewards and penalties — it can be substantial.

Medical practices today are navigating a complex environment—health care reform, increased competition, and payment incentives and penalties.  These payment systems are changing constantly making it difficult for practices to stay current.

Eagle consultants understand the latest rules and know the interrelationships between the Physician Quality Reporting System (PQRS), Meaningful Use and Value-Based Payment Modifier incentive programs and help practices maximize their incentive payments with the minimum amount of practice labor.

The Physician Quality Reporting System is intertwined with both the Meaningful Use and Value-Based Payment Modifier Incentive programs.

CMS provides several reporting mechanisms for PQRS data submission which vary depending on whether you are participating in PQRS as an individual EP or as part of a PQRS group practice.

Individual EPs may report information on individual PQRS quality measures or measures groups using the following mechanisms:

(1) Medicare Part B claims
(2) Qualified PQRS registry
(3) Direct electronic health record (EHR) using certified EHR technology (CEHRT)
(4) CEHRT via data submission vendor
(5) Qualified clinical data registry (QCDR)

Group Practices may report information on PQRS quality measures using the following mechanisms:

(1) Qualified PQRS registry
(2) Web Interface (for groups of 25+ only)
(3) Direct EHR using CEHRT
(4) CEHRT via data submission vendor
(5) CAHPS for PQRS via CMS-certified survey vendor (for group practices of 2+) to supplement PQRS group practice reporting

Choosing Reporting Strategies:  Eagle works with you to select the reporting method, the individual measures or measure group and the data collection method that works best for your practice.   Practices must choose either 1 Measures Group, or 9 individual measures across 3 National Quality Strategy (NQS) domains.  Those choosing individual measures must also report one (1) cross-cutting measure.  Practices using electronic records may collect these measures using their EHR system, and use the same measures to satisfy with their Meaningful Use quality reporting requirement.

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From CMS:

Individual EPs and group practices who do not satisfactorily report data on quality measures for covered professional services will be subject to a negative payment adjustment under PQRS beginning in 2015. The PQRS negative payment adjustment applies to all of the EP’s or group practice’s Part B covered professional services under the Medicare Physician Fee Schedule (PFS). Review information on the PQRS Payment Adjustment page for complete information on how to avoid future PQRS payment adjustments.

How you report in 2016 will affect your reimbursements in 2018!

No. of HIPAA Compliance Cases with Corrective Action from HHS (source: HHS.gov)

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