’Tis the CMS season of giving, and that means the 2016 Final Rule is out—thus, it’s time to prepare for PQRS. If it’s your first time reporting, you may be a bit confused by the different reporting options. Don’t worry; we were there once, too. That’s why we did a little—well, a lot—of research and put it all together in an easy-to-understand post (you’re totes welcome). Here’s what we know:
Individual Claims-Based and Individual Registry-Based
For most providers, these two reporting methods are the only available options, so let’s discuss them first:
For both individual claims-based reporting and individual registry-based reporting (both of which WebPT offers), eligible providers (EPs) are subject to these requirements:
- EPs must report on nine measures across three NQS domains for at least 50% of their Medicare Part B FFS patients.
- If fewer than nine measures apply, EPs must report on all the measures available to them (up to eight measures) for at least 50% of their Medicare Part B FFS patients.
- If an EP sees at least one Medicare patient in a billed visit during 2016, then he or she must report on at least one cross-cutting measure, even if fewer than nine measures apply to the EP.
- When fewer than nine measures covering three NQS domains are reported, EPs are subject to Medicare’s Measures Applicability Validation (MAV) process, which allows Medicare to identify whether an EP should’ve reported quality data codes for additional measures.
These two reporting methods differ in only one area: the number of available measures. Here’s the breakdown:
- Individual Claims-Based
- PTs: Six measures
- OTs: Nine measures
- SLPs: Three measure
- Individual Registry-Based
- PTs: Eight measures
- OTs: Ten measures (Note that there are only nine measures available to OTs within WebPT)
- SLPs: Three measure
This means that PTs and SLPs will automatically go through the MAV process regardless of the reporting method chosen. OTs, on the other hand, have enough measures applicable to them for both reporting types.
GPRO (Registry Only)
Now, if your clinic has two or more eligible professionals, then you also have one other reporting method to consider: GPRO. No, this isn’t a video recording tool; it’s Medicare’s Group Practice Reporting Option, which has two options for satisfactory reporting:
- Report on at least nine measures across three NQS domains for at least 50% of your Medicare Part B FFS patients. (Note that WebPT only offers this option for GPRO reporting.)
- Report on six measures across two NQS domains, and complete a CAHPS survey. (Please note that this survey is required for groups with 100 or more eligible professionals.)
As with the first two reporting options, EPs who report via GPRO are subject to these requirements:
- If fewer than nine (or six) measures apply, your group must report on all the measures available to you (up to eight measures) for at least 50% of your Medicare Part B FFS patients.
- When fewer than nine (or six) measures covering three NQS domains are reported, the group practice is subject to the MAV process, which allows Medicare to identify whether a group practice should have reported quality data codes for additional measures. So, if your group consists of only SLPs, it’ll automatically go through the MAV process—which includes a review of cross-cutting measure applicability.
- If your group sees at least one Medicare patient in a billed visit during 2016, the group must report on at least one cross-cutting measure.
But, wait just a tick: I know I said there were only two options, but that wasn’t totally true. Groups with 25 or more—but fewer than 99—eligible professionals also can choose to report via the GPRO Web Interface. While CMS has yet to release information regarding any 2016 changes, as far as we can tell, the requirements are the same as last year:
- Your group must report on all measures included in the Web Interface for your first 248 Medicare Part B patients.
- If your group has fewer than 248 Medicare patients, it must report on at least one measure for 100% of your Medicare Part B patients.
So, there you have it: the three PQRS reporting options for 2016. One final note: Keep in mind that CMS won’t count any measures with a 0% performance rate, regardless of the reporting method you choose. Like Goldilocks, you might need a try or two to find just the right fit for your practice, but this summary should help narrow down your options. Still feeling unsure—or just want more PQRS information? Don’t miss our upcoming webinar, PQRS 2016: Everything PTs, OTs, and SLPs Need to Know, at 9:00 AM PST on December 9, 2015.