10 Things You Should Know About PQRS for 2015
In our recent webinar on PQRS, Dr. Richard Snow and Dr. Seth Flam, our speakers, provided excellent information, for which we thank them. We had so many good questions that we couldn’t answer them all in the time available, so we’d like to address more questions here.  This is the first part of our two-part blog.

Q. What is the deadline to submit 2014 PQRS data?

A. Submission of EHR data must be completed in the first quarter following the reporting year. For more information: https://questions.cms.gov/faq.php?id=5005&faqId=2127#sthash.ThOCQVsm.dpuf

Q. Are there any specific quality measures to be tracked for a podiatry practice?

A. No, there are never any required measures based on profession. HealthFusion has developed the Podiatrists’ Guide to Reporting for PQRS which lists and describes the top ten measures we recommend for podiatrists to report via their EHR software. You can download the free guide now.

Q. If we meet the PQRS reporting requirement, it sounds like we will automatically be compliant with Meaningful Use.  What if we fail?  Is there is a penalty for both PQRS and MU?  Are there two different penalties?

A. If you meet PQRS you should meet Meaningful Use assuming you are using the EHR method and the same set of measures for each program, although the measurement period may be different depending on how you decide to report. If you report Meaningful Use manually, you will report for one quarter; if you report electronically (a single file for both Meaningful Use and PQRS), you will report for a year. And yes, if your PQRS file meets the standard for reporting 9 measures from 3 domains, you will meet Meaningful Use. There are 2 different penalties. You can find more information on reporting for PQRS and Meaningful Use in our free guide, The Insider’s Guide to Understanding Clinical Quality Measures for Meaningful Use and PQRS.

Q. Can you clarify the statement on 2013 reporting and being able to appeal it in the first quarter of 2015?

A. According to the CMS FAQ website, starting with data submitted for the 2011 PQRS, eligible professionals can request an informal review of their data, which may include questioning the results of MAV analysis. The individual eligible professional will need to request his or her own informal review for the individual National Provider Identifier (NPI) for each Tax Identification Number (TIN) under which (s)he submitted PQRS quality-data codes. Each year CMS will determine a time period during which informal review requests may be submitted.

After submitting a valid PQRS informal review request, CMS (via the QualityNet Help Desk) will perform an internal review of the data and will e-mail the EP a summary of his or her results.

Q. What if fewer than 10% of eligible hospitals/doctors report for Meaningful Use?  What are the penalties and bonuses?

A. It is unlikely that less than 10% of the Eligible Providers will meet Meaningful Use. In the next few years, the penalties for Meaningful Use for Eligible Providers that fail are adjusted for the percentage of Eligible Providers that meet Meaningful Use. See the following tip sheet: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ PaymentAdj_HardshipExcepTipSheetforEP.pdf

Q. On one slide, Dr. Snow referred to “MOC”—what does that stand for?

A. MOC stands for “Maintenance of Certification,” referring to Board Certification for one of the 24 approved medical specialties.

Q. Please explain why Dr. Snow mentioned Value-Based Modifiers as being “too early to use”?

A. The Value-Based Modifier program does not apply until Jan. 1, 2015 for small and solo practices.

Q. Is the reporting period for PQRS one year?  So if I started EHR use 4 months ago I can’t report PQRS for 2014?

A. The reporting period for PQRS is 12 months for 2014. However, you could report via registry if you only recently began using an EHR. You may benefit from using the group measure method. The AOA CAP program may offer alternatives that will work for your practice.

Q. Do you have to submit an E/M code to qualify for the measure under PQRS?

A. For many measures an E/M code is required for the patient to meet the measure’s denominator – it is dependent on the measure.

Q. What if my practice does not accept Medicare insurance?

A. PQRS currently only impacts Medicare reimbursement, so if your practice doesn’t see Medicare patients, you may not need to report for the program.

Q. What do you estimate the financial cost of installing additional software to record and calculate the PQRS information and submit?  Please compare the penalties or lack of % of reimbursement that will in 2015 if the requirements of meaningful use and PQRS data is not submitted?

A. The cost of software will of course depend on the software. In the case of MediTouch, there is no additional charge for the features in our software related to tracking PQRS or for the QRDA file you will need to submit. We recommend that you review your options carefully, as it is entirely possible to report for PQRS via the EHR method without spending any additional monies.

We appreciate the excellent questions submitted by our webinar participants, and the very informative presentations by Dr. Richard Snow and Dr. Seth Flam. If you missed the webinar, you can view the recording in our Resource Center at any time. Like what you just read? Continue reading the second part of this Q&A here – PQRS: What You Need to Know and How to Report Webinar Q&A, Part II.

Be sure to register now for our next webinar, The Value-Based Modifier: What’s the Impact on Your Practice? Don’t miss this informative program featuring Dr. Barbara J. Connors, Chief Medical Officer at The Centers for Medicare & Medicaid Services Region III.