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.

Big Rock 2 - Payment Reform - Regular BannerBig Rock 2 - Payment Reform - Small Banner
  • articleNov 29, 2011

    PQRS: The Case for Registry over Claims Based Reporting

    Here at WebPT HQ, we are gearing up for PQRS 2012. One of the pieces of PQRS that is most commonly misunderstood is the difference between claims and registry based services. Let's take a minute and clear this up. Claims and registry-based reporting both result in the same outcome for your clinic-- successful participation in PQRS. WebPT offers both options with claims-based being priced $99 per calendar year and registry-based at $299 for the calendar year. Many …

  • 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 …

  • webinarDec 20, 2013

    Preparing for PQRS 2014

    In December, we hosted a webinar focused on the new PQRS regulations. This session broke down all the rules for 2014 to ensure you’ll be prepared to play by them and therefore not incur any penalties. During this presentation, we: Detailed the PQRS requirements for 2014 Described the different reporting methods Explained how you can ensure you successfully report

  • 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 …

  • Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015 Image

    articleNov 13, 2014

    Here's What PTs, OTs, and SLPs Need to Know About PQRS 2015

    In the spirit of the season, today we give thanks for Medicare’s brand new Final Rule . Drier than overcooked turkey, we decided to carve up this bird into the most pertinent chunks of Physician Quality Reporting System (PQRS) information for you and your practice so you don’t have to. Here’s what you need to know about PQRS 2015: Measures, Measures, Measures Medicare likes measures––225 of them to be exact––and they don’t care who knows. Thankfully, all …

  • 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 …

  • articleNov 4, 2013

    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 …

  • articleDec 23, 2013

    Changes to PQRS Measures Specifications for 2014

    On Friday, Medicare released the 2014 specifications for individual PQRS measures. Not much has changed compared to last year; however, there are a few noteworthy differences, which we’ve detailed below. (Please note that there weren’t any major changes for speech language pathologists.) Measure 131: Pain Assessment Physical and occupational therapists can now report this measure during re-evaluations (97002 and 97004). In 2013, they could only report it during initial evaluations. Measure 155: Falls POC In 2013, therapists …

  • articleNov 18, 2010

    What PTs Should Know About 2011 Final Rule Medicare Changes

    Some major changes are headed our way in terms of the 2011 Medicare Final Rule on the Physician Fee schedule and Other Policies to be effective January 1, 2011.  The Rule included a number of provisions that have impact on outpatient therapy services. The net effect of the policies could lead to payment reductions of approximately 30%. If you see Medicare patients and they impact your revenue, there are several things to pay attention to and deal …

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