With temperatures soaring—especially here in Phoenix—summertime is definitely upon us. That means you’re probably making family vacation plans, relaxing poolside, and doing a mid-year PQRS compliance audit—er, okay, maybe not that last one. But, in all seriousness, this is the perfect time of year to check your clinic's PQRS compliancy. After all, we’re halfway through the calendar year—which means we’ve reached the midpoint of the 2016 PQRS reporting period.

Before we jump into the nitty-gritty of auditing your PQRS compliance, I want to emphasize the importance of PQRS: failure to meet the criteria for satisfactory reporting this year will result in a 2% penalty for all of your Medicare payments in 2018. Do the little extra work now and you’ll save big later.

Okay, on to the audit! To assess your compliancy, you need to understand two critical requirements:

  • You must have a reporting rate of at least 50%. The reporting rate is the number of patients an eligible professional (EP) reported (met, not met, and excluded) divided by the EP’s total number of eligible patients.
  • You must have a performance rate of at least 1%. CMS will not count any measures with a 0% performance rate. This is an important detail, because it means EPs cannot simply mark all eligible patients as “not met” for any particular measure. Rather, EPs must select a satisfactory answer (i.e., take a quality action) for at least 1% of the patients who are eligible for each measure.

Auditing your mid-year PQRS compliance entails verifying the reporting and performance rates for each measure on which you’re required to report. Of course, you may be wondering what, exactly, constitutes a performance or satisfactory response. To better understand this concept, let's look at an example:

Measure 128 requires the EP to calculate the patient’s BMI and indicate a follow-up plan if it is above or below normal parameters. There are seven possible responses for this measure:

  1. BMI Calculated as Normal, No Follow-up Plan Required
  2. BMI Documented as Above Normal Parameters and Follow-up Documented
  3. BMI Documented as Below Normal Parameters and Follow-up Documented
  4. BMI not Documented, Patient not Eligible
  5. BMI Documented Outside of Normal Limited, Follow-up Plan Not Documented, Patient not Eligible
  6. BMI not Documented, Reason not Given
  7. BMI Documented Outside of Normal Parameters, Follow-Up Plan not Documented, Reason not Given

Responses 1-3 are considered performance responses. This means that the actions required by the measure were completed and fully-documented. Performance responses count toward both the reporting (>50%) and performance (>1%) rates.

Responses 4-5 are considered performance exclusion responses. These responses are typically used to indicate that a patient is not eligible for the measure. Performance exclusion responses count toward the reporting rate (>50%), but they do not count toward the performance rate (>1%).

Responses 6-7, are considered non-performance responses. These answers indicate that the actions required for successful reporting of the measure were not completed and that no further information or reason was provided. Non-performance responses count toward the reporting rate (>50%), but they do not count toward the performance rate (>1%).

Note: WebPT Members can see all PQRS measure response breakdowns in this WebPT Community article.

Now, determining your mid-year reporting and performance rates for every applicable measure might seem like a daunting task. For WebPT Members with registry-based PQRS, though, checking compliance through our PQRS Status Report is a snap. The report is a tool clinic admins can use to assess high-level reporting and performance data. If issues exist—that is, if either the reporting or performance rate is not met for a particular measure—the user can investigate the reason for the deficiency with a single click. The clinic can then adjust reporting practices accordingly, thus ensuring compliance by the end of the year. With all that time saved, you’ll have more room in your schedule for important decisions—like choosing where to go for that family vacation.

Medicare Open Forum - Regular BannerMedicare Open Forum - Small Banner
  • Breaking News: 2017 MACRA Final Rule Hits Image

    articleOct 17, 2016 | 4 min. read

    Breaking News: 2017 MACRA Final Rule Hits

    After months of heated debate and public commentary—much of it coming from physicians who felt they needed more time to prepare themselves to participate in a brand-new quality reporting program—the Department of Health & Human Services (HHS) on Friday released its final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) . This act, which will go into effect January 1, 2017, reimburses eligible Medicare physicians based on the quality of care they deliver …

  • Founder Letter: Dodging Data will be Your Demise (or, Why You Should Complete PQRS)  Image

    articleNov 5, 2015 | 6 min. read

    Founder Letter: Dodging Data will be Your Demise (or, Why You Should Complete PQRS)

    By and large, Medicare’s 2016 Final Rule was underwhelming—and for most of us (including me), that probably warranted a big sigh of relief. But while there are no major changes on deck for this year, one thing that definitely should have caught your eye if you perused our Quick Guide to the 2016 Final Rule was the verbiage alluding to the future of PQRS—specifically, the possibility that PQRS reporting as we know it could cease to exist …

  • articleNov 5, 2013 | 3 min. read

    Founder Letter: PQRS 2014

    Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- …

  • Think You Know PQRS? [Quiz] Image

    articleDec 2, 2015 | 1 min. read

    Think You Know PQRS? [Quiz]

    PQRS 2016 is on the horizon, and whether you’re an old pro or a reporting rookie, the details of this Medicare quality data program can be tough to keep straight. And with a potential 2% negative payment adjustment on the line, it’s imperative that you understand every facet of this quality data reporting program from A to Z—er, P to S. Think you’ve got PQRS down pat? Prove your smarts with our ten-question quiz. Need a bit …

  • Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments Image

    articleMay 4, 2016 | 6 min. read

    Odd Provider Out: Why PT Exclusion from MIPS is Bad for Future Payments

    It’s official: rehab therapists are just a sashay away from exiting the PQRS dance floor. That’s because last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed final rule that, if adopted, will put into effect the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). And that, in turn, will give the green light to the Merit-based Incentive Payment System (MIPS) , a brand spankin’-new quality data reporting program that consolidates PQRS , …

  • PQRS 2016 FAQ Image

    articleDec 10, 2015 | 17 min. read

    PQRS 2016 FAQ

    Yesterday, we hosted a webinar focused on PQRS 2016. We received a lot of questions during the live session—so many, in fact, that we’ve amassed them here in a handy FAQ. Got a question and don’t see an answer below? Ask it in the comment section at the bottom of this post. Eligibility Do I have to participate in PQRS? What makes me an eligible provider? If you are a healthcare professional providing services paid under or …

  • articleNov 4, 2013 | 3 min. read

    What PQRS Could Look Like in 2014

    On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) in the Federal Register. According to this summary , most of the policies were open for comment until September 6, 2013 and, pending final decisions (which hopefully will occur this month), will take effect on January 1, 2014. The 605-page document contains proposals for policy changes on everything from reimbursements to the …

  • The Rehab Therapist’s Quick Guide to the 2016 Final Rule Image

    articleNov 4, 2015 | 6 min. read

    The Rehab Therapist’s Quick Guide to the 2016 Final Rule

    November is finally here, which means we here at WebPT can’t stop thinking about a juicy, flavorful, hot-out-of-the oven—Medicare Final Rule. While your tastebuds probably aren’t jumping with joy over the thought of chewing over a bunch of regulatory gobbledygook, the good news is that this year’s final rule shouldn’t be too tough to swallow (and if it is, you can always add more gravy). We’ve already picked out the most important pieces and served ’em up …

  • 5 Things PTs, OTs, and SLPs Need to Know About PQRS 2016 Image

    articleNov 10, 2015 | 4 min. read

    5 Things PTs, OTs, and SLPs Need to Know About PQRS 2016

    Ah, fall. The leaves are changing, we’re consuming pumpkin-flavored everything, and healthcare providers across the country are poring over the Medicare Final Rule to learn all the requirements for satisfying PQRS in 2016. Maybe that last thing isn’t one of the festive fall traditions we’ve all come to love, but it is a fall tradition nonetheless. It is our sixth year covering PQRS here at WebPT, after all. So, without further ado, here’s what you need to …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.