Participation in the Physician Quality Reporting System is now a requirement for all providers accepting payments based on the Physician Fee Schedule for Medicare Part B beneficiaries. This includes practitioners and therapists as well as physicians. A disincentive in the form of a 4% negative payment adjustment will be applied in 2018 to any provider that fails to report adequate quality measures for 2016 (which includes the 2% negative adjustment for the Value Measure program).
The selection of measures to report should be done strategically, as the information submitted will be use in the Value-based Payment Modifier program to calculate payment adjustments that can be negative, neutral or positive. Negative adjustments are applied depending on the size of the group. For 2016, only groups of 100 or more providers can receive a negative adjustment, based on quality performance reporting for 2014. This expands to groups of 10 or more in 2017, based on 2015 performance. The gradual phase-in of this program means that all providers will be subject to payment adjustments by 2018 based on quality data reported for 2016, so the selection of quality measures on which to report will have a significant effect on future Medicare payments.
Click here for a complete list of all quality measures available in the PQRS program for 2016, in Excel spreadsheet format. Providers must report on 9 quality measures that cross at least 3 of the 6 National Quality Strategy domains:
New for 2016, if the provider sees at least one (1) Medicare patient in a face-to-face encounter, at least one of these 9 measures must be a 'cross-cutting' measure that is broadly applicable across multiple providers and specialties
The reporting process for quality measures can be done through a variety of channels, each of which present varying costs and complexities:
ACI can help your organization avoid negative pay adjustments in future years by implementing adequate quality reporting mechanisms this year. Call us today for a free evaluation.