In our effort to simplify the clinical environment while maintaining quality and compliance, we decided to dedicate this month the exciting topic of Medicare Regulations. This topic can to be either terrifying or boring for PTs, but it is something that must be considered and is equally important in patient care.

This article aims to clear up some of the most common questions regarding the program formally known as PQRI. For your convenience I have translated the legislative jargon into plain English.

Note:  WebPT is one of 2 certified PQRI Registries in the Physical Therapy space. We have just finished updating our module to the 2011 specifications. WebPT members can contact their member representatives to learn how to activate this feature and begin participating in this program.

What are PQRI and PQRS?
PQRI stands for the Physician Quality Reporting Initiative. This program is administered by the Center for Medicare and Medicaid Services (CMS). In regular governmental fashion, CMS has recently changed the program to a permanent feature rather than a temporary initiative (as of January 2011). In light of this adjustment the name of PQRI was changed to PQRS. PQRS stands for the Physician Quality Reporting System. This is the new lingo so let’s get with it. (I’m also trying to light a fire under CMS here– their website is not even updated with the new name yet).

What is the purpose of PQRS?
PQRS exists to establish a standard of ‘satisfactory reporting’ for Medicare Claims. The idea is that by setting this standard, CMS can reduce the amount of fraud and optimize how payments are given. In return for the extra work, they give your clinic and additional 1% bonus on charges for the Medicare Part B Physician Fee Schedule. This is down from the 2% offered in 2010, but get on the train before the end of 2013 or you'll suffer 1.5% penalties starting in 2015. 

A 1% Bonus? Sweet! Sign me up!
Not so fast. To become eligible for this bonus you have to complete more than one of the eligible measures for a certain percentage of Medicare patients. There are a number of measure you can choose from, utilizing an EMR being one of them. The percentage of patients that need to be documented using these standards to receive your bonus is 50% for claims based and 80% for registry based.

What’s the difference between claims-based and registry-based reporting?
Claims based is the type that you submit yourself and registry based is the type that is stored and submitted for you. WebPT is a PQRS Registry. Read our next article or keep an eye on our Resource page for a complete comparison rundown.

How can I sign up for the WebPT PQRS Registry?
WebPT members can contact a WebPT representative to learn more about using WebPT as a PQRS registry. 

How can I learn more?
Join WebPT on February 24 or 26 for an informational webinar about improving Medicare and PQRS documentation in your PT clinic that can help your bottom line. Led by EMR expert and practicing therapist Heidi Jannenga, PT, and technology expert Michael Mannheimer, you'll learn how to painlessly take advantage of PQRS incentives and improve your Medicare billing.

During this 1 hour webinar, you'll learn:

 

  • What is PQRS and why should you care?
  • Is it true that PQRS will be mandatory?
  • What measures are available and best for my clinic?
  • How can I improve my Medicare documentation?
  • What is an outcome measurement tool?
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  • 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 …

  • articleNov 7, 2013 | 2 min. read

    FLR and PQRS: How Are They Different?

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  • 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- …

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    articleOct 24, 2016 | 5 min. read

    Last Legs: The Compliance Vulnerabilities of Dead or Dying Software

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    articleJan 17, 2014 | 5 min. read

    PQRS Back Pain Measures Group Clarification

    It’s a new year, and you know what that means: a new PQRS reporting period. Many WebPT Members have already started reporting PQRS data—and that’s great. The sooner you begin reporting, the sooner you’ll reach the minimum reporting requirements and thus ensure you avoid the 2% penalty. As you might recall from this blog post , you have a few different options when it comes to satisfactory PQRS reporting. For those practitioners who treat a large population …

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    articleMay 24, 2016 | 25 min. read

    The Complete PT Billing FAQ

    Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. (And be sure to check out this separate PT billing FAQ we recently put together.) Questions …

  • PQRS 2016: Everything PTs, OTs, and SLPs Need to Know Image

    webinarNov 4, 2015

    PQRS 2016: Everything PTs, OTs, and SLPs Need to Know

    At this point, you’d think satisfying PQRS requirements would be child’s play, but unfortunately, Medicare changes the rules every year. Fortunately, we’ve already combed through the 2016 Final Rule for you and organized everything you need to know about PQRS into a jam-packed, super educational 60-minute webinar. Join us for this beneficial seminar, where hosts Heidi Jannenga and Charlotte Bohnett will: detail 2016 reporting requirements; describe the different reporting methods; and explain how to ensure you successfully …

  • articleNov 6, 2013 | 2 min. read

    Functional Limitation Reporting in a Nutshell

    Hopefully, you’ve been working your functional limitation reporting (FLR) magic for months now, so you’ve got it down pat. If not, you’re probably running into more than your fair share of claim denials. Don’t worry; we’re here to help. Here are some FLR basics in a convenient chestnut shell. (It is almost that time of the year , after all). What is FLR? Beginning July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) require that …

  • 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 …

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