decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 11 (November)
Quality reporting: Use your resource reports to prep for PQRS 2016, beat the value-based cut
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Article Overview
This article discusses how physician practices can use Medicare quality and resource reporting summaries to understand their performance under PQRS-linked payment programs. It focuses on the purpose of the QRUR, the role of CMS performance summaries, and the general relationship between quality reporting, value-based payment adjustments, and the separate PQRS payment penalty. The piece is aimed at practices, physicians, and billing or coding staff monitoring Medicare quality-reporting requirements and payment exposure.
Why This Topic Matters
The article is relevant because it explains where practices can look for Medicare performance feedback before value-based payment adjustments are applied. It helps readers understand how PQRS participation, QRUR review, and CMS reporting timelines affect practice-level and physician-level reimbursement.
Article Sections
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Prepare for the value-based modifier using quality reporting reports
Introduces the Medicare quality reporting context and explains why practices are being directed to review their reporting summaries in advance of payment adjustments.
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Download and study your QRUR
Describes the quality and resource use report and its role as a practice-level summary used to review performance and identify areas for improvement.
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Focus on quality if cost-cutting is hard
Discusses the relationship between quality performance, cost concerns, and the separate payment consequences tied to quality reporting participation.
What You Will Learn
- How Medicare quality reporting summaries fit into value-based payment preparation
- What the QRUR is used for at a high level
- Why practices are encouraged to review performance feedback before payment adjustments are finalized
- How PQRS participation and payment adjustment programs are related in broad terms
- Why quality performance remains important when cost management is challenging
Who Should Read This
- Physician practices
- Physicians
- Billing staff
- Coding staff
- Quality reporting staff
- Practice administrators
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