Once I pick my measures within WebPT, am I stuck with those throughout the year or can I change them?

Yes, whichever measures you select will be your measures for the remainder of the year. You have until March 31, 2014, to make your final selection.

 Is the requirement for successful reporting with the back pain measures group 20 patients per therapist or 20 patients per practice?
It’s 20 patients per therapist. It doesn’t matter if you’re participating in GPRO, if a therapist joins the practice belatedly in the year, if a therapist leaves the practice, or if a therapist is full-time equivalent, part-time, or PRN—it’s still 20 per therapist. However, in the case of part-time, PRN, or a therapist leaving a practice, the penalty applies to the individual and not the practice.

 Is there still time to avoid the noncompliance penalty for 2013? If so, how?
Yes, there is still time to avoid the 2013 penalty by completing PQRS on one patient through a paper claim, but you must act quickly. Here’s how:

  1. Choose a measure to report on from this list.

  2. Report on that one measure for at least one patient at one visit.

  3. Add the appropriate data to the claim form and submit it before December 31, 2013. This claims submission PDF from Medicare details electronic submission; information for submitting claims begins on page 8.

For more detailed information on claims-based PQRS reporting, check out this CMS resource.

Can different therapists report different measures?
All therapists of each speciality within a clinic must report the same measures. However, therapists of different specialities (e.g., occupational, physical, and speech language), may report on different measures as certain measures are only applicable to certain specialties.

What are the incentive and penalty amounts for 2014? What do I have to do to obtain the incentive? How do I avoid the penalty?
In 2014, there is a 2% penalty and a 0.5% incentive. The criteria for earning the incentive and avoiding the penalty differ based on which reporting option you select. For a comprehensive explanation of the requirements for each reporting method, check out this blog post.

To hedge my bet, can I report the back pain measures and individual measures?
No. Unfortunately, you cannot report on group measures and individual measures simultaneously. You must pick one or the other. So, if you are unsure of whether you will see 20 patients who qualify for the back pain measures group, you should report individual measures. If that's the case, you'll need to assess whether it's worth it for you to report to earn the incentive (i.e., eight measures) or merely to avoid the penalty (i.e., three measures).

What is GPRO? How does it differ from claims and registry? How do I sign up?
The Group Reporting Option (GPRO) is a registry-only reporting method available for multi-therapist practices (i.e., two or more therapists who share the same tax ID) that wish to report PQRS together. The reporting requirements for those participating in GPRO are identical to the those for individuals. The only difference is that CMS will assess the requirements at the clinic level instead of the individual level. (Please note, however, that if you choose to report on the back pain measures group, each therapist must meet the 20 patient minimum individually.)

How do we find the measures and their specifications for 2014?
On December 20, CMS released the 2014 PQRS measures specifications. Visit this site, look for a link called "2014 PQRS Individual Claims Registry Measure Specification Supporting Documents," and click that link to download the document containing all the measures and their specs.

When can we select our measures in WebPT? How long do we have to select?
You may select your measures within WebPT anytime from December 28, 2013, to March 31, 2014. However, we strongly recommend that you select your measures and begin reporting as early as possible to ensure that you have enough time to meet the reporting requirements.

What are the ICD-9 codes that qualify for the back pain measures group?
The ICD-9 diagnosis codes that apply to back pain are: 721.3; 721.41; 721.42; 721.90; 722.0; 722.10; 722.11; 722.2; 722.30; 722.31; 722.32; 722.39; 722.4; 722.51; 722.52; 722.6; 722.70; 722.71; 722.72; 722.73; 722.80; 722.81; 722.82; 722.83; 722.90; 722.91; 722.92; 722.93; 723.0; 724.00; 724.01; 724.02; 724.09; 724.2; 724.3; 724.4; 724.5; 724.6; 724.70; 724.71; 724.79; 738.4; 738.5; 739.3; 739.4; 756.12; 846.0; 846.1; 846.2; 846.3; 846.8; 846.9; 847.2

What if nine measures do not apply to me?
If fewer than the required measures apply, you’re only required to report on the ones that do. However, you will be subject to the Measures Applicability Validation (MAV) process. This is the process by which Medicare determines whether you should have reported on additional measures. For more information on how to comply (earn the incentive and/or avoid the penalty) in this situation, please check out this blog post.

Is PQRS required if Medicare is the secondary insurance policy? What about replacement plans?
PQRS is only required for patients who have Medicare proper as their primary or secondary insurance. Patients with Medicare replacement or Medicare Advantage plans (Part C) are technically commercially insured and thus, are not PQRS-eligible.

What is the benefit to using registry-based reporting?
With claims-based reporting, you submit all of your own reporting information to CMS. And because you’re in control of your data, the burden of compliance is completely on your shoulders. If you report via a Certified PQRS Registry like WebPT, on the other hand, the registry handles most of PQRS for you. WebPT, for example, merges PQRS with your standard documentation, so all you have to do is report your measures directly within your notes. Then, we compile your data and submit it to CMS on your behalf.

Where do I learn more about PQRS through WebPT?

Non-WebPT Members
Experience our PQRS live and in-action, learn about our EMR solution, and ask any questions during an online demo. Click here to schedule one.

WebPT Members
Click here to learn more about our PQRS solution and submit a request to sign up for PQRS. You can also contact membervalue@webpt.com or 866-221-1870, option 5.

Breaking Bad Habits: The Modern PT’s Formula for Success - Regular BannerBreaking Bad Habits: The Modern PT’s Formula for Success - Small Banner
  • webinarDec 20, 2013

    Preparing for PQRS 2014

    In December, we hosted a webinar focused on the new PQRS regulations. This session broke down all the rules for 2014 to ensure you’ll be prepared to play by them and therefore not incur any penalties. During this presentation, we: Detailed the PQRS requirements for 2014 Described the different reporting methods Explained how you can ensure you successfully report

  • 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 …

  • 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- …

  • PQRS 2016 Measures Image

    articleNov 19, 2015 | 1 min. read

    PQRS 2016 Measures

    While PQRS measures specifications won’t be available until December, we do know which measures are available for 2016. Here’s the breakdown by specialty: Physical Therapy #126 Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation #127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear #128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up #130 Documentation of Current Medications in the Medical Record #131 Pain Assessment and …

  • articleNov 7, 2013 | 2 min. read

    FLR and PQRS: How Are They Different?

    Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

  • 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 …

  • 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 …

  • The Scoop on PQRS Image

    articleNov 18, 2013 | 5 min. read

    The Scoop on PQRS

    What is PQRS? The Centers for Medicare and Medicaid Services (CMS) developed Physician Quality Reporting System (PQRS), which mandates that eligible professionals meet standards for satisfactory reporting. If you are not PQRS-compliant in 2014, CMS will assess penalties. However, we do not yet know what the penalty amount is or how CMS will assess it. There also is a chance that CMS will provide incentive payments for successfully completing PQRS, as they did in 2013. Again, we …

  • Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015 Image

    articleNov 13, 2014 | 8 min. read

    Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015

    In the spirit of the season, today we give thanks for Medicare’s brand new Final Rule . Drier than overcooked turkey, we decided to carve up this bird into the most pertinent chunks of Physician Quality Reporting System (PQRS) information for you and your practice so you don’t have to. Here’s what you need to know about PQRS 2015: Measures, Measures, Measures Medicare likes measures––225 of them to be exact––and they don’t care who knows. Thankfully, all …

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