The Art of Documentation and Reporting

The Physician Quality Reporting System (PQRS)¹ was created under the Tax Relief and Health Care Act of 2006 as a Medicare quality incentive program. In 2008, the Medicare Improvements for Patients and Providers Act made the program permanent. It was this act that included increased PQRS incentive payments. Over time, the program has expanded its opportunities for reporting and is aligning with other governmental initiatives including Physician Compare, Value-Based Payment Modifier (VBM), Electronic Health Record (EHR) Incentive Programs, Million Hearts,^® Medicare Shared Savings Program, Pioneer Accountable Care Organization (ACO) model, and Comprehensive Primary Care (CPC) Initiative. Once an incentive program, PQRS is now a reporting program that applies negative payment adjustments to promote reporting of quality information by individual eligible professionals (EPs) and group practices identified by their individual national provider identifier (NPI) and tax identification number (TIN).

Beginning in calendar year (CY) 2015, the program applied a (negative) -2% payment adjustment to individual EPs and PQRS group practices that did not satisfactorily report data on quality measures for the Medicare Part B Physician Fee Schedule (MPFS)-covered professional services in 2013. Those EPs who reported satisfactorily for the 2015 program year avoided the 2017 PQRS negative payment adjustment.² Turning to this reporting year, there is a (negative) -2% adjustment applied in CY 2018 (based on program year 2016 data submission) to individual EPs and PQRS group practices that do not satisfactorily report data on quality measures for MPFS-covered professional services. Additionally, the VBM program was added to measure cost and quality, with associated penalties and incentives as well.³ To that end, PQRS reporting and the VBM program are complex and require thoughtful attention and engagement on behalf of the EP.

Read the rest of this article in Today’s Wound Clinic.

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