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"PQRS" Articles
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December 18th, 2018
Quality Measures Finalized for 2019
By Wyn Staheli, Director of Research | Published December 18th, 2018
CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are:
Physical therapists
Occupational therapists
Qualified speech-language pathologists
Qualified audiologists
Clinical psychologists
Registered dietitian or nutrition professionals
The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...
December 8th, 2017
Quality Reporting and Payment Reduction
By ChiroCode | Published December 8th, 2017 - Last Review/Update January 30th, 2019
Checking my NPI number on the CMS site.
September 29th, 2017
Don't do the MIPS Minimum
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published September 29th, 2017 - Last Review/Update March 4th, 2019
Doing the MIPS Minimum - Penny Wise but Pound Foolish?
Are you planning to “do the MIPS minimum” - the “Test” reporting option - in 2017 and submit the minimum amount of data possible to avoid the penalty? Perhaps every silver lining does not have a cloud, but “Pick Your Pace” sure does. Just as we cheered when the SGR was buried, only to see MIPS emerge from the grave, perhaps the “Pick Your Pace” regulations should undergo more scrutiny before we throw our hats into the air at this regulatory “reprieve.”
August 24th, 2017
Q/A: MIPS and G Codes
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 24th, 2017 - Last Review/Update February 5th, 2019
We have one doctor in our practice who qualifies under the MIPS guidelines so he is continuing to use the PQRS and G-codes. We are having the rest of our doctors do the same, just in case, and because it is good practice, but is that completely unnecessary and can it possibly do us more harm than good?
December 28th, 2016
Medicare’s Quality Payment Program: Getting Paid for Value Instead of Volume
By ChiroCode | Published December 28th, 2016 - Last Review/Update February 8th, 2019
The government has become increasingly concerned with how they spend money in the healthcare sector. As part of the latest proposal to fix this, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015. This law changes reimbursement to remunerate providers more when they provide high quality care rather than just more care. It rewards value over volume. It also ends the flawed Sustainable Growth Rate (SGR) formula that had been in use to determine Medicare payment for many years. And, it combines three other quality-based programs into one. It’s biggest and lasting impact may be how it influences the way that patients select the provider they choose to see.
December 15th, 2016
International Classification of Diseases (ICD)-10 Code Updates and Impact to 4th Quarter 2016 Eligible Professional Medicare Quality Programs
By CMS.gov | Published December 15th, 2016
On October 1, 2016, new International Classification of Diseases (ICD)-10-CM and ICD-10-PCS code sets went into effect. Updating of these codes traditionally occurs on an annual basis, however, during the immediate years leading up to the ICD-9 to ICD-10 transition there was an extended freeze to code updates to support...
September 9th, 2016
Looking forward to a 9% payment increase for Medicare Part B
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 9th, 2016
What in the world is MACRA, MIPS and APM? More acronyms, rules and payment changes are headed our way. If you are a Medicare Part B provider, you will want to pay special attention.
MACRA- Medicare Access and CHIP Reauthorization Act of 2015
MIPS- Merit-Based Incentive Payment System
APM – Alternative Payment Model ...
September 9th, 2016
CMS offering options for MACRA Participation. You Choose - Be prepared!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 9th, 2016
The most recent Blog Post from CMS has given a new update on The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS states they will allow providers four options of reporting for the first year of the program stating they can pick their pace of participation for the ...
March 29th, 2016
PQRS Measures for Behavioral Health (2014)
By Wyn Staheli, Director of Research | Published March 29th, 2016
Performance Measurement Codes for Behavioral Health:
Although there are hundreds of Performance Measurement (PM) services and events, only a few could be reported for behavioral health services for the 2014 reporting year. For 2014, there were seventeen PQRS measurements that could relate to behavioral health services:
Anti-depressant Medication Management
9
Medication Reconciliation
46
Advance Care Plan
47
Adult ...
March 29th, 2016
PQRS Measures for Behavioral Health (2015)
By Wyn Staheli, Director of Research | Published March 29th, 2016
Performance Measurement Codes for Behavioral Health:
Although there are hundreds of Performance Measurement (PM) services and events, only a few could be reported for behavioral health services for the 2015 reporting year. For 2015, the following PQRS measurements are those that are most likely to relate to behavioral health services:
Anti-depressant Medication ...
March 29th, 2016
PQRS Measures by Specialty (2016)
By InstaCode Institute | Published March 29th, 2016
Download CMS's Preferred PQRS Measures Lists by Specialty. 17 Specialties to choose from. Find out exactly what CMS is expecting to see reported for your specialty.
January 29th, 2016
What is MIPS?
By Wyn Staheli, Director of Research | Published January 29th, 2016
The Merit-Based Incentive Payment System (MIPS) combines PQRS, VM, and EHR into a single Medicare pay-for-performance quality payment system scheduled to begin in 2019.
September 30th, 2015
CMS will begin to apply a negative payment for 2014 PQRS
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2015
Here we go, CMS will begin to apply a negative payment adjustment to EP’s (Eligible Professionals) that did not participate and satisfactorily report Physician Quality Reporting System (PQRS) in 2014. Remember, the program participation during a calendar year will affect your payments in two years. Therefore; if you do to ...
August 19th, 2015
First Physician Fee Schedule Proposed Rule Since SGR Repeal
By Wyn Staheli, Director of Research | Published August 19th, 2015
Even though the SGR has been repealed, providers still need to be aware of annual fee revisions by CMS. On July 8, 2015, CMS announced their first proposed Medicare Physician Fee Schedule (MFPS) since the SGR repeal. As in years past, there will continue to be reviews of the Relative Value ...
July 20th, 2015
Medicare Rules: What You Need to Know About the Value-Based Modifier
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 20th, 2015
The Affordable Care Act requires CMS to begin applying a new modifier known as the "value-based modifier" in 2015, part of its ongoing effort to move away from fee-for-service towards pay-for-performance.
For 2015, the modifier will only apply to physicians who are in a group of 100 or more participating providers, ...
June 25th, 2015
Certification of Mammography Facilities (Rev. 1387, 04-07-08)
By Jared Staheli | Published June 25th, 2015
The Mammography Quality Standards Act (MQSA) provides specific standards regarding those qualified to perform screening and diagnostic mammograms and how they should be certified. The MQSA requires the Secretary to ensure that all facilities that provide mammography services meet national quality standards. Effective October 1, 1994, all facilities providing screening ...
June 25th, 2015
Services Under Arrangements (Rev. 1387, 04-07-08)
By Jared Staheli | Published June 25th, 2015
When mammography services are obtained for patients under arrangements with another facility, the provider arranging the service must ensure that the facility performing the services has been issued an MQSA certificate by the FDA.
...
March 6th, 2015
Antipsychotic Drug use and Patient Care
By Wyn Staheli, Director of Research | Published March 6th, 2015 - Last Review/Update February 18th, 2016
In an effort to improve quality of care in nursing home, CMS has been reviewing PQRS quality measures and offering provider training through a variety of mediums. Antipsychotic drug use is just one of the measures being reviewed. The MLN Connects Provider eNews for February 12, 2015 included the following notice about ...
February 21st, 2015
PQRS in Find-A-Code - With all Crosswalks and Measures
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update February 18th, 2016
Find-A-Code has all of your PQRS Codes and Measures, including Crosswalks to ICD-9, ICD-10, HCPCS and CPT. With a click of your mouse you have access to PQRS data built right into the Code Information page. Once the desired code has been selected, simply click on the green + at the ...
February 21st, 2015
PQRS - CMS-1500 Claim Example
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update February 18th, 2016
Need help with completing claim forms? Check out this PDF from CMS showing how to correctly fill out a CMS-1500 Claim form for Physician Quality Reporting System (PQRS).
...
February 21st, 2015
PQRS 2015 Payment Adjustment
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 21st, 2015 - Last Review/Update February 18th, 2016
2015 PQRS Payment Adjustment
The applicable percent for payment adjustments under PQRS are as follows:
• 1.5% adjustment in 2015 (EP or group practices participating in GPRO will receive 98.5% of his/her allowed Medicare Part B PFS (Physician Fee Schedule) amount for covered professional services that would otherwise apply to such services)
• 2.0% ...
February 15th, 2015
PQRS CMS.gov Interactive Timeline - Don't Miss the Deadlines!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2015 - Last Review/Update February 18th, 2016
Don't miss your deadlines! Keep up on when PQRS reporting ends and begins as well as Incentive Program deadlines. Visit the CMS.gov Interactive Timeline.
...
November 25th, 2014
Have you checked your QRUR to find out if you qualify for a CMS bonus (or penalty)?
By | Published November 25th, 2014 - Last Review/Update January 30th, 2017
What? You've never heard of a QRUR?
You have probably heard about Meaningful Use (MU) and penalties that kick in for those who did not attest. And the Physician Quality Reporting System (PQRS) with penalties for those who did not successfully report on at least one patient. The new one ...
October 29th, 2014
Getting Ready for 2015
By | Published October 29th, 2014 - Last Review/Update January 30th, 2017
Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In effort to aid in the preparation of this year, here are some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees: Fee schedules ...
October 17th, 2014
New PQRS and EHR Incentive Programs FAQs Available
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 17th, 2014 - Last Review/Update January 30th, 2017
CMS has added two new FAQs to their website.
CEHRT Day 1 FAQ: This FAQ provides information regarding when Certified Electronic Health Record Technology (CEHRT) must be implemented to be successful for 2014 PQRS reporting.
2014 Registry XML NPI Validation FAQ: This FAQ provides guidance on the error message received when registries ...
September 25th, 2014
PQRS: Questions and Answers for Psychologists
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 25th, 2014 - Last Review/Update January 30th, 2017
Questions and Answers for Psychologists and PQRS. In 2007, Psychologists had very limited opportunity to participate in PQRS. As of 2014, there are 11 measures available for claims-based reporting and two for registry reporting.
For the entire article read more here: PracticeCentral.org
Below are the 11 new measures for 2014
Major depressive disorder: diagnostic evaluation (#106)
Major ...
September 18th, 2014
PQRS Web Based Training
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 18th, 2014 - Last Review/Update January 30th, 2017
The CMS Physician Quality Reporting System (PQRS) Program: "What Medicare Eligible Professionals Need to Know in 2014” Web-Based Training Course — Released
“The CMS Physician Quality Reporting System (PQRS) Program: What Medicare Eligible Professionals Need to Know in 2014” Web-Based Training (WBT) Course was released and is now available. This WBT ...
August 27th, 2014
PQRS FAQS
By | Published August 27th, 2014 - Last Review/Update January 30th, 2017
PQRS FAQs: How do I report for the 2014 PQRS? What is the MAV and when does it apply? What happens if we report less than 9 measures across 3 domains? How does CMS apply the MAV Clinical Relation/Domain test for PQRS?
July 24th, 2014
Are Medicare fees going up? Or down?
By | Published July 24th, 2014 - Last Review/Update January 29th, 2016
Are Medicare fees going up? Or down? Results for the following:
Sequestration
Chiropractic Demonstration Project
Electronic Health Record/Meaningful Use
Physician Quality Reporting System - PQRS
Value-Based Modifier
March 2nd, 2014
Will mandatory Medicare payment cuts (due to the SGR) get repealed?
By | Published March 2nd, 2014 - Last Review/Update January 27th, 2017
Since 2003, healthcare providers have been dealing with the the short term patches to the Medicare payment system. After all this time, it now appears that Congress is making a move to address the ongoing issues with the Sustainable Growth Rate (SGR). This is the formula that has caused the payment problems with Medicare. Many professional organizations are endorsing the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015, S. 2000) and encouraging providers to contact their congressional leaders and lend their support for this legislation. If you wish to join those lending their support CLICK HERE for a helpful tool to contact YOUR congressional leaders.
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