Understanding PQRS reporting requirements for 2016 and beyond

The Physician Quality Reporting System (PQRS) encourages individual eligible professionals (EPs) and group practices to report information on quality of care to Medicare.

EPs with Medicare Part B Fee for Service patients must satisfactorily report PQRS quality measures or receive a penalty of reduction in pay through a negative payment adjustment. PQRS negative payment adjustments affect payments for services rendered 2 years after the program participation year, meaning that 2016 reporting affects 2018 payments. Those who report satisfactorily for the 2016 program in 2017 will avoid the 2018 PQRS negative payment adjustment.

CEHRT can help

Individual EPs and group practices participating under the PQRS Group Practice Reporting Option that use an electronic health record (EHR) to report quality measures electronically may avoid the PQRS negative payment adjustment. To align with the Medicare EHR Incentive Program, EHR systems must be certified EHR technology (CEHRT).

2016 requirements

For 2016 reporting, EPs must report at least 9 measures, covering a minimum of 3 National Quality Strategy domains. If the CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, the EP must report all the measures for which there are Medicare patient data. An EP must report on at least 1 measure containing Medicare patient data and report on all payers. With the EHR, this information can be submitted electronically to CMS.

Quest Diagnostics offers an ONC HIT 2015 certified (CEHRT) solution that can be used for PQRS reporting. This solution is intended for any Care360 EHR provider participating in PQRS as a means to help avoid the 2% negative payment adjustment for 2018. Providers that contract for the fee-based Care360 PQRS solution prior to March 10, 2017 will have access to the 2016 data residing within Care360 EHR. This can be used to create and submit reports by the new March 31, 2017 submission deadline.

2017 is different

Realize that the 2017 calendar year will be handled differently. The PQRS program has been replaced by a new quality reporting program known as the Merit-based Incentive Payment System (MIPS). It is expected that most practices will report quality data under MIPS in 2017, unless they are new to Medicare or are below the low-volume threshold. MIPS consolidates PQRS, Meaningful Use, and the value modifier into one program, and is part of the Quality Payment Program (QPP), formerly known as the Medicare Access and CHIP Reauthorization Act (MACRA). MIPS moves Medicare Part B clinicians to a performance-based system that measures 4 categories: Quality, Cost, Improvement Activities, and Advancing Care Information. The Quality category of MIPS replaces PQRS and makes up 60% of the final score.

The first year of reporting for MIPS is slated to begin on January 1, 2017 and will impact payments in 2019. To read more about the QPP, see our recent blog post. Despite these changes from PQRS to MIPS, an EHR will still be needed to report quality measures, and you can successfully report using 2014 or 2015 certified EHR technology.

Your Quest Diagnostics team can help guide you through these changing requirements. Talk to a representative at 1.888.835.3409.

Get more information on the Quanum EHR.

Sources: Physicians Practice, CMS


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