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 don’t know that information either. Once the federal government finalizes the 2014 Physician Fee Schedule Proposed Rule, we will be able to detail the incentives, penalties, and approved measures.

Originally, CMS stated that they would meet to discuss finalizing the Proposed Rule by November 1, but due to last month’s government shutdown, this meeting was delayed until November 27. We’re hoping once they meet, we’ll have a better idea of what PQRS 2014 will truly entail in terms of reporting requirements, measures, penalties, and incentives.

Who are eligible professionals?

According to CMS, “under Physician Quality Reporting System (PQRS), covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services [that] get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments.” Physical therapists, occupational therapists, and qualified speech-language therapists are all eligible professionals who are able to participate in PQRS. (Click here to view the full list of eligible professionals who are able to participate.)

Now, some professionals who are eligible according to their specialty may not be able to participate due to their billing method. CMS provides the following examples:

  • Professionals who provide Medicare Part B services, but bill under Part A (i.e., at a facility or institution)
  • “Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services”
  • “Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing” (CAH doesn’t include the individual NPI on their Institutional FI claims)
  • Professionals who provide services payable under fee schedules or methodologies other than the Medicare Physician Fee Schedule (e.g., services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals, rural health clinics, ambulance providers, and ambulatory surgery center facilities)

Why WebPT?

While it may seem daunting, overwhelming, or both, PQRS is absolutely necessary—and with WebPT, it’s simple, especially when you let us manage PQRS for you. CMS approved us as a Certified PQRS Registry, and this is the fourth year we’ve been helping our Members successfully complete PQRS. WebPT makes it easy to stay compliant; plus, you get a trustworthy partner who always has your back. 

Here are the benefits:

  • Avoid noncompliance penalties (and maybe even earn an incentive)
  • Improve measure reporting efficiency through our EMR
  • Ensure practice and documentation compliance
  • Elevate your clinic’s standard of care while saving yourself time, money, and stress

What are the reporting methods?

There are three different methods for reporting PQRS:

Registry-Based (Automatic Individual Submission)
With this option, WebPT manages most of PQRS for you. Because we merge PQRS with standard documentation, you simply report your PQRS measures directly within the patient record. We then aggregate that data, compile it digitally, and submit it to CMS. So, after setup, you document, and we take care of the rest. Essentially, registry-based reporting means you’ll never forget PQRS because we remember for you.

Group Practice Reporting Option (GPRO) (Automatic Group Submission)
This registry-based method of reporting is for multi-therapist practices (clinics with two or more therapists) that wish to report PQRS as a group. Essentially, therapists who share one tax ID for their practice may report measures together to reach the required percentage for satisfactory reporting. 

Because this method is registry-based (and not available for claims-based), WebPT will manage PQRS for the practice. However, last year this option required practices to sign up (self opt-in) for GPRO directly with CMS. We do not yet know if this is the case for 2014.

Claims-Based (Manual Individual Submission)
Claims-based reporting allows you to use your WebPT documentation to help you complete PQRS. We will guide you in proper code selection and provide accurate billing data; however, it is your responsibility to make sure those codes are submitted properly on your Medicare claim forms.

Why should I pick registry-based over claims-based reporting?

If you’re a Type A personality, being in control of your own data might seem appealing. But consider this: Choosing claims-based reporting means that you must be your own auditor—and that can be tedious, time-consuming, and distracting from patient care. Of course, if you’re a smaller practice and Medicare patients make up a tiny portion of your payer mix, then you might want to consider this option. Otherwise, claims-based reporting will require more work, more time, and more responsibility for you and your clinic. In short, it’ll be up to you to ensure you stay compliant. Talk about pressure. That’s why we recommend registry-based reporting. Ultimately, though, no matter which reporting method you choose, you’re better protecting your practice from penalties. 

Do you have more PQRS questions? Ask them in the comments below, and remember, as soon as CMS releases the details of PQRS 2014, we’ll share them on our blog. Stay tuned.