Share

The Physician Quality Reporting Initiative (PQRI) is a program designed by the Center for Medicare and Medicaid Services (CMS) to improve the quality of reporting in the healthcare industry. The program is now considered to be permanent and therefore the program name has been amended to the Physician Quality Reporting System (PQRS). PQRS reporting is based on individual measures which are associated to a specific patient group by diagnosis, ailment, age, or clinical action taken by the reporting therapist. All Medicare Part B FFS (fee for service) patients are eligible, but must meet inclusion criteria for each measure.

There are 2 methods of reporting your clinical data to CMS:  Claims-based and Registry.  Choosing your reporting method is very important in reaching your 1% incentive goal.  What is the difference between the 2 methods?  What are the Pros and Cons of each?  Let’s explore:

Claims-based Reporting
With claims-based reporting, measures are tied to clinical practice reported on claims with CPT codes that link to measures. Data submission is the responsibility of the eligible professional or group practice themselves or your billing company may offer this service for an extra fee.

To qualify for your 0.5% incentive, you must report on at least 3 measures and report on 50% of eligible patients (this is a reduction from the 80% requirement of 2010).

Advantages of claims-based reporting

  1. You are in control of your own data from completion to submission
  2. Self auditing process developed to your clinic’s specific needs
  3. Cheaper – no added cost
  4. Only 50% reporting requirement
  5. OK for smaller practice or if Medicare is a small portion of your payer mix

Disadvantages of claims-based reporting:

  1. Must have someone in the clinic who will own this project: complete audits, know all the ins/outs of PQRS, keep record of the % completed
  2. Auditing process can be tedious and potentially a productivity loss for an employee
  3. You must complete and submit the proper forms in proper format for the eligible patients
  4. Workload could be significant if large % of your patients are Medicare or part of a large clinic
  5. No internal automated check/balance system completed by the billing company: submits only what you give them

Registry-based Reporting
With registry-based reporting, the eligible professional or group practice submits the data electronically to the registry, who then captures and stores the measure related data. The registry is then responsible for submitting the individual measure or measures group information to CMS on behalf of eligible professionals.  Registries provide CMS with calculated reporting and performance rates at the end of the reporting period.  Registries must pass stringent reporting method criteria annually and be qualified to participate. WebPT is one of only two certified EMR registries available in the PT industry.

Check out the most current list of Qualified Registries for 2010 PQRI Reporting is available at the CMS website. (The 2011 list has not been updated on the CMS website yet).

To qualify for your 0.5% incentive, you must report on at least 3 measures and report on 80% of eligible patients.

Advantages of registry-based reporting:

  1. Form creation and submission is done for you
  2. No need for auditing due to the EMR enforcing measure criteria and selecting eligible patients
  3. Staff productivity maintained
  4. Higher potential for meeting the reporting criteria and receiving your 0.5% incentive bonus
  5. Using a PT specific EMR registry gives you added insight and assistance with choosing most appropriate measures
  6. Measures are updated automatically each year as information is provided by CMS.

Disadvantages of registry-based reporting: 

  1. There is a cost involved; but if using WebPT it is nominal and definitely provides an ROI when staff time, paper/office supplies, and decreased stress levels are calculated
  2. 80% reporting requirement, but with the EMR in place, 100% data collection should be the expectation.
  3. Data collection enforcement with all eligible patients – no choice but to report on each patient

The 1% incentive may not seem like much of a bonus if you have to spend staff time and effort to get the proper codes into billing, complete audits to ensure your clinic is meeting its minimum criteria, and manually submitting claims to CMS. Although there is a cost associated with using a registry, the savings on staff time and maintaining productivity alone will be worth it.  

It also makes sense to choose a PT specific registry, like WebPT, which gives you the tools and outlines the measures in a way that streamlines to your workflow.  To me, registry reporting just makes more sense – leave the technical automated reporting method to the experts and let me use my clinical expertise to provide valuable feedback on how PTs impact patients’ lives daily.

Webinar: April 2015 - Regular BannerWebinar: April 2015 - Small Banner
  • articleNov 6, 2012

    Pass the PQRS, Please!

    Today's blog post comes from WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L. Can you believe it’s already November? That means two things: Thanksgiving and PQRS 2013 (if you treat Medicare patients, of course). I know we’d much rather fill our thoughts—and bellies—with turkey, dressing, and buttery mashed potatoes. But you have to make room somewhere for Physicians Quality Reporting System (PQRS, formerly known as PQRI). You can’t smother it with gravy or tuck it behind excess cans …

  • articleJan 11, 2011

    Webinar Update from CMS

    The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program. The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA.  The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx …

  • webinarFeb 7, 2011

    Take the Pain Out of Medicare (PQRS/PQRI Compliance)

    Improving Medicare and PQRS documentation in your PT clinic that can help your bottom line. This webinar was led by EMR expert and practicing physical therapist Heidi Jannenga and technology expert Michael Mannheimer. Webinar attendees will learn the answers to: What is PQRS and why should I care? Is it true that PQRS will be mandatory? What Medicare changes have been enacted recently? What measures are available and best for my clinic? How can I improve my …

  • articleFeb 22, 2011

    Maximize Your Chances of Getting the PQRS Incentive by Choosing the Right Measures

    As we have discussed in a previous blog, there are 2 methods of reporting your PQRS data to CMS:  Claims-based or Registry based .  Both have their advantages and disadvantages.  Once you have decided on a reporting method, how do you decide on what measures to report on?  Here are some tips on making this important decision. 1.  Diagnoses or clinical conditions treated in your clinic :  Having eligible patients who qualify for the measures you choose …

  • articleFeb 12, 2013

    PQRS in a Nutshell

    What is PQRS?  Created by Center for Medicare and Medicaid Services (CMS), Physician Quality Reporting System (PQRS) mandates that physical therapists, occupational therapists, and qualified speech-language therapists meet the standards for satisfactory reporting. If you are not PQRS compliant in 2013, CMS will assess penalties of 1.5% of your Medicare payments as fines in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period. Why …

  • Final Rule 2015: Here’s What You Need to Know Image

    articleNov 6, 2014

    Final Rule 2015: Here’s What You Need to Know

    The summary of this year’s Final Rule is hot off the presses, which means that—among other things—we now know the details regarding PQRS 2015. For those who have been following the PQRS saga since the program first came into being in 2007, it should come as no surprise that Medicare has yet again upped the ante for compliance. Based on the fact sheet CMS provided , here’s the scoop on this year’s reporting requirements: Eligible professionals who …

  • articleSep 6, 2011

    CMS, Patient Level Data and Outcomes: What should we be measuring?

    What should we be measuring? Recently, there has been some debate from EMR providers over the type of data that should be provided to CMS when reporting clinical outcomes. CMS, in a newly proposed rule, wants to define and begin to use a new measure called CQM . CQM stands for Clinical Quality Measure and is used to establish the top tier providers for the effectiveness and necessity of specific treatments.   The Issue The issue here …

  • articleNov 2, 2011

    PQRS and Broccoli

    Just like eating your broccoli is not required, neither is PQRS. If you don’t do it, however, eventually you’ll get fined. And if you don’t eat your broccoli, Mom will probably send you to your room. Or worse, no dessert.  PQRS is one of those things that Mom may advise you to do. Why? Because it’s good for you. If you and your clinic start adopting your workflow for PQRS now, you’ll be better prepared for the …

  • webinarNov 14, 2011

    Getting Your Clinic Set Up with PQRS for 2012

    WebPT is 1 of 2 Certified PQRS  registries in the PT space. Like most governmental systems, the PQRS progam is ever changing. Earlier this month some of the standards withing the PQRS program were changed/updated . This webinar is a great place for clinic owners to walk throught the steps necessary to get you clinic set up for 2012. This webinar was hosted by WebPT Co-Founder Heidi Jannenga PT, MPT, ATC/L and Marketing Manager Michael Manheimer.

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