PQRS

2016 Physician Quality Reporting System (PQRS)


PQRS
2016 Participation Year – PQRS Penalty 2% + VBM Penalty 2% – 4% = 4% – 6% Total Penalty

Physician Quality Reporting System (PQRS) – Program in which eligible professionals report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Patients.

Although there is no incentive for 2016, successful reporting in 2016 is crucial to potentially avoid both the PQRS penalty and the possible -2%-4% CMS VBP payment adjustment.  View the 2016 PQRS Implementation Guide on the CMS website.

MediSYS is a certified EHR Data Submission Vendor (DSV) which means we can submit data from MediSYS EHR on our client’s behalf for certain PQRS measures.  Please request a complete list of measures available for MediSYS EHR data submission.  This service is offered FREE for all MediSYS EHR clients.

 

Getting Started

  1. Are you eligible to participate? 2016 List of Eligible Professionals
  2. Determine your PQRS reporting method. An eligible professional may choose from the following methods to submit data to CMS:

 

Requirements

˜For PQRS Data Submission or Claims report on at least 9 measures across at least 3 National Quality Strategy (NQS) Domains:

  1. Patient Safety
  2. Person and Caregiver-Centered Experience and Outcomes
  3. Communication and Care Coordination
  4. Effective Clinical Care
  5. Community/Population Health
  6. Efficiency and Cost Reduction

View the CMS 2016 PQRS Measure Codes List (Note: Measures get retired each year, please see CMS website for the updated list of PQRS codes for your attestation method)

 

Cross Cutting Measures Requirement

At least 1 cross-cutting measure must be satisfactorily reported for those individual providers with face-to-face encounters.

Eligible professionals or group practices are required to report one (1) cross-cutting measure if they have at least one (1) Medicare patient with a face-to-face encounter. The Centers for Medicare & Medicaid Services (CMS) defines a face-to-face encounter as an instance in which the EP billed for services that are associated with face-to-face encounters under the Physician Fee Schedule (PFS). This includes general office visits, outpatient visits, and surgical procedure codes; however, CMS does not consider telehealth visits as a face-to-face encounter.

View the CMS 2016 Cross-Cutting Measures List and reference the 2016 PQRS List of Face-To-Face Encounter Codes  for the billable codes that identify face-to-face encounters for the purposes of PQRS reporting.

 

CMS Specialty Measure Set

Per CMS, the Specialty Measure Sets should be used as a guide for eligible professionals to choose measures applicable to their specialty. The Specialty Measure Sets are NOT required measures but are suggested measures for specific specialties.  

The 2016 Specialty Measure Sets are indicated below.

  1. 2016 Cardiology Preferred Specialty Measure Set
  2. 2016 Dermatology Preferred Specialty Measure Set
  3. 2016 Emergency Medicine Preferred Specialty Measure Set
  4. 2016 Gastroenterology Preferred Specialty Measure Set
  5. 2016 General Practice/Family Practice Preferred Specialty Measure Set
  6. 2016 General Surgery Preferred Specialty Measure Set
  7. 2016 Hospitalist Preferred Specialty Measure Set
  8. 2016 Internal Medicine Preferred Specialty Measure Set
  9. 2016 Mental Health Preferred Specialty Measure Set
  10. 2016 Multiple Chronic Conditions Preferred Specialty Measure Set
  11. 2016 Obstetrics/Gynecology Preferred Specialty Measure Set
  12. 2016 Oncology/Hematology Preferred Specialty Measure Set
  13. 2016 Ophthalmology Preferred Specialty Measure Set
  14. 2016 Pathology Preferred Specialty Measure Set
  15. 2016 Physical Therapy/Occupational Therapy Preferred Specialty Measure Set
  16. 2016 Radiology Preferred Specialty Measure Set
  17. 2016 Urology Preferred Specialty Measure Set

*Please request a complete list of measures available for MediSYS EHR data submission

 

2016 PQRS Educational Materials

  • The “2016 Implementation Guide,” available on the PQRS How To Get Started webpage, contains information for individual eligible professionals and PQRS group practices participating in 2016 PQRS.
  • The 2016 PQRS measures documents, for those reporting via the claims and registry reporting mechanism, are located on the PQRS Measures Codes webpage
  • The 2016 group practice reporting option (GPRO) Web Interface measures documentation is available on the PQRS GPRO Web Interface webpage.
  • The PQRS Spotlight webpage contains a list of all recent documents and resources. Please check this page regularly for updates.The 2016 PQRS measures documents, for those reporting via the claims and registry reporting mechanism, are located on the PQRS Measures Codes webpage.
Need Assistance?
Contact the QualityNet Help Desk:
Monday – Friday; 7:00 AM – 7:00 PM CST
Phone: 1-866-288-8912
TTY: 1-877-715-6222
Email: Qnetsupport@hcqis.org
 

For more information about participating in PQRS, visit the CMS PQRS website.