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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    Founder Letter: PQRS 2014

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    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

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