Practice Point: Quality Measures and Physician Quality Reporting System (PQRS)

In last month’s column, Quality Measures and Meaningful Use, we discussed how the Centers for Medicare “ Medicaid Services (CMS) has aligned quality reporting programs, including the Electronic Health Records (EHRs) Incentive Program (Meaningful Use) and the Physician Quality Reporting System (PQRS). Collecting this level of documentation for CMS, from a specialty outpatient wound care department, ultimately allows CMS to review the quality metrics reported, thereby improving the quality of life of patients living with chronic wounds.

Physician Quality Reporting System

Let’s review PQRS reporting. The PQRS is a CMS program that uses a combination of incentive payments and adjustments to promote reporting of quality information by eligible professionals (EPs). Specifically, the reported data focus on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service beneficiaries. The EPs who do not participate in PQRS reporting in 2014 will face negative payment adjustments beginning in 2016. Both EPs and group practices receiving a PQRS payment adjustment in 2016 will be paid 2.0% less than the PFS amount for services rendered from January 1 to December 31, 2016 (or receive 98% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services). The reporting period for the 2016 PQRS payment adjustment is the 2014 program year. There are step-by-step instructions outlined by CMS in Getting Started with the PQRS¹:

STEP 1

Determine if you are eligible to participate for purposes of the PQRS incentive payment and payment adjustment. A list of eligible medical care professionals considered eligible to participate in PQRS is available through the CMS website. Read this list carefully, as not all entities are considered “eligible professionals” because they are reimbursed by Medicare under other fee schedule methods than the PFS.

STEP 2…

Read the rest of the article at Advances in Skin & Wound Care.

An excerpt from an article originally published in Advances in Skin & Wound Care, written by Cathy Thomas Hess, BSN, RN, CWOCN, VP and Chief Clinical Officer at Net Health