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:
Choose a measure to report on from this list.
Report on that one measure for at least one patient at one visit.
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?
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.