E/M Coding Alert - 2015 Issue 7
Quality Reporting: Ignore PQRS at Your Peril - Penalties Await
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Article Overview
This article explains how Medicare quality reporting and value-based payment programs relate to one another and why they matter to physician practices. It covers the transition from voluntary reporting to payment adjustments, the role of group size in implementation timing, the use of quality and cost measures in payment evaluation, and the kinds of reporting resources practices should review to prepare. The content is aimed at physicians, group practices, and coding/billing or practice management staff who need to understand the broad reporting landscape and its payment implications.
Why This Topic Matters
Practices that do not participate appropriately in quality reporting may face Medicare payment reductions, and the impact can vary based on group size and reporting status. Understanding the overall framework helps practices plan ahead for reporting, feedback review, and payment-impact assessment.
Article Sections
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PQRS — Yesterday, Today, and Tomorrow
Introduces the Physician Quality Reporting System and its evolution over time. Discusses participation, eligibility, and the broader shift from voluntary reporting to payment consequences.
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Check Out VBPM Facts
Summarizes the value-based payment modifier and its relationship to Medicare payment adjustment timing. Covers group-size phase-in, the use of quality and cost information, and related reporting concepts.
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Know How You’re Scored
Explains the general scoring framework used for payment evaluation, including quality tiering and report-based performance review. Also notes optional patient experience reporting and the role of feedback reports.
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How You Can Prepare
Offers broad preparation guidance for practices reviewing their reporting obligations and feedback resources. Focuses on planning considerations tied to group size and reporting awareness.
What You Will Learn
- How major Medicare quality-reporting programs are connected
- Why participation status can affect future payment adjustments
- How group size influences reporting and implementation timing
- What types of reports and performance summaries practices may review
- How quality and cost measurement concepts fit into payment evaluation
Who Should Read This
- Physicians
- Group medical practices
- Practice managers
- Billing and coding professionals
- Healthcare administrators
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