In my September column, "Overcoming the Challenges of PQRS," I noted that the APA Practice Organization (APAPO) was exploring options to partner with a qualified registry for participation in Medicare's Physician Quality Reporting System (PQRS). We are pleased to announce that our registry has launched and is available to all psychologists who participate in Medicare. APAPO has teamed up with Healthmonix, a leading health-care data and technology company, to offer PQRSPRO to psychologists in individual and group practices. The registry is accessible online and is available for a flat rate of $199 per reporting year.
The Centers for Medicare and Medicaid Services (CMS) introduced the Physician Quality Reporting Initiative (now known as PQRS) in 2007 as part of a nationwide effort to reduce health-care costs and improve patient outcomes.
PQRS is a first step toward tying Medicare payments to improved patient outcomes, though it is not a pay-for-performance program. Initially, PQRS was a voluntary pay-for-reporting bonus program. Now, the system imposes payment adjustments on Medicare providers who fail to report quality measures on services provided to Medicare beneficiaries. There are three ways to participate in PQRS: claims-based reporting, reporting through a CMS-approved registry and electronic health record submission. However, the Medicare final rule on the 2015 fee schedule indicated that CMS will not continue to support claims-based reporting indefinitely.
Though many eligible professionals (EPs) prefer claims-based reporting, participants have higher rates of successful participation when they report through registries and electronic health records. Registries collect and transmit PQRS quality measure data directly to CMS, so that practitioners do not have to submit measures through claims-based reporting. The PQRSPRO registry meets CMS's strict criteria, such as having secure methods for data transmission and providing feedback to registry participants.
CMS data show that claims-based reporting has only a 56 percent success rate, while registry reporting has a 96 percent success rate. Healthmonix had a 99 percent success rate in 2013 with other partner organizations. In the past, Medicare's PQRS payments have been retroactive: Eligible professionals submitted their Medicare claims and were paid, with PQRS bonus payments distributed later. But now that PQRS is becoming a penalty-based program, Medicare must operate prospectively to have the time needed to analyze reporting data before adjusting payments. The 2 percent penalty for 2016 will be based on 2014 reporting data.
If you are a Medicare provider who has not yet participated in PQRS, you still have time to avoid the 2 percent penalty in 2016. Providers have until mid-February 2015 to submit data through PQRSPRO and until Feb. 28, 2015 through claims-based reporting, to meet the PQRS requirements for 2014. Even if you have already filed claims to Medicare and received payment for your services, you can still report PQRS data through a registry to potentially receive the 0.5 percent payment bonus for 2014 and avoid the payment penalty for 2016.
If you have already begun submitting data for 2014 through claims-based reporting, you can still participate through the registry as well, though CMS will not combine the data from the two reporting methods. CMS will examine both sets of data and determine if one of the two meets the PQRS requirements for successful reporting. Healthmonix will review your data for errors and omissions to identify as many applicable measures as possible. The registry can be used to report measures even after a claim for the service has already been submitted and paid, something that is not possible with claims-based reporting.
The latest information for both new participants and those already reporting in the program appears in the Quality Improvement Programs section of APAPO's Practice Central website. These resources include a list of measures available for 2014 and 2015, a quick reference guide that links applicable codes to each measure, frequently asked questions and video tutorials for PQRS reporting.
