What PQRS Could Look Like in 2014On 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 Physician Compare tool on the Medicare website, but today, let’s focus on what the rule proposes for the 2014 Physician Quality Reporting System (PQRS). Here are some of the highlights:

  • Eligible practitioners who do not satisfactorily complete PQRS in 2014 may receive a 2% payment adjustment (penalty) in 2016 for services they provide under the Medicare physician fee schedule.
  • Eligible practitioners who do satisfactorily complete PQRS in 2014 may earn a 0.5% bonus (note: 2014 would be the last year to earn an incentive.)
  • CMS may require practitioners to report measures from a certain number of the six categories of the National Quality Strategy (NQS) domains:
    • Person and Caregiver-Centered Experience Outcomes
    • Patient Safety
    • Communication and Care Coordination
    • Community/Population Health
    • Efficiency and Cost Reduction
    • Effective Clinical Care

Individual PQRS Reporting

  • Claims Reporting
    • Providers may need to report at least nine measures, covering three of the NQS domains, and report each measure for at least 50% of eligible patients.
    • The reporting period may be 12 months, from January 1 through December 31.
    • CMS is currently seeking comments as to whether or not they should eliminate the claims-based reporting option for PQRS 2017.
  • Registry Reporting
    • Providers may need to report at least nine measures, covering three of the NQS domains, and report each measure for at least 50% of eligible patients.
    • The reporting period may be 12 months, from January 1 through December 31.

GPRO PQRS Reporting

  • Registry Reporting
    • A group of two or more eligible practitioners may need to report at least nine measures, covering three of the NQS domains, for at least half of the group’s eligible patients. This would have to be done through a registry.
    • The reporting period may be 12 months, from January 1 through December 31.

 Measures Group Reporting

  • Registry Reporting
    • Beginning in 2014, measures groups may need to consist of at least six measures (instead of four), and in order to report measures groups, you may have to do so through a registry.
    • Proposed Back Pain Measures Group:
      • Documentation of Current Medications in the Medical Record (new)
      • Pain Assessment and Follow-Up (new)
      • Back Pain: Initial Visit
      • Back Pain: Physical Exam
      • Back Pain: Advice for Normal Activities
      • Back Pain: Advice Against Bed Rest

According to the American Medical Association, under the proposed rule, practitioners can avoid the 2016 penalty adjustment (although they won’t earn the incentive) by reporting three measures (instead of nine) for 50% of eligible patients.

Looking for some more great rule resources? If you’re an APTA member, you can download their highlights of the 2014 proposed rule here. If you’re not—or if you’d rather hear it from us—check out this WebPT blog post, where WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L, and Senior Writer Charlotte Bohnett break down the APTA highlights.

Documentation - Regular BannerDocumentation - Small Banner
  • articleNov 5, 2013

    Founder Letter: PQRS 2014

    Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- …

  • articleNov 7, 2013

    FLR and PQRS: How Are They Different?

    Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

  • 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 …

  • 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

  • The Scoop on PQRS Image

    articleNov 18, 2013

    The Scoop on PQRS

    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 …

  • articleDec 26, 2013

    Most Frequently Asked Questions from our PQRS Webinar

    Once I pick my measures within WebPT, am I stuck with those throughout the year or can I change them? Yes, whichever measures you select will be your measures for the remainder of the year. You have until March 31, 2014, to make your final selection.   Is the requirement for successful reporting with the back pain measures group 20 patients per therapist or 20 patients per practice? It’s 20 patients per therapist. It doesn’t matter if …

  • articleNov 6, 2013

    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 …

  • PQRS Back Pain Measures Group Clarification Image

    articleJan 17, 2014

    PQRS Back Pain Measures Group Clarification

    It’s a new year, and you know what that means: a new PQRS reporting period. Many WebPT Members have already started reporting PQRS data—and that’s great. The sooner you begin reporting, the sooner you’ll reach the minimum reporting requirements and thus ensure you avoid the 2% penalty. As you might recall from this blog post , you have a few different options when it comes to satisfactory PQRS reporting. For those practitioners who treat a large population …

  • 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 …

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