The Final Rule detailed a lot of changes for PQRS 2015. Here is what PTs, OTs, and SLPs need to know.
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 of Medicare patients with back pain, we recommended reporting on the back pain measures group, as it is by far the easiest way to not only avoid the penalty, but also earn the 0.5% incentive payment that is available to those who report to the highest possible degree.
Initial Visit vs. Episode
However, the wording Medicare used to explain the requirements for the back pain measures group was a bit confusing, and we’ve received several requests for clarification. According to Medicare’s specifications for this measure (Measure #148: Back Pain: Initial Visit), eligible patients must have a qualifying back pain diagnosis and must not have been “seen or treated for back pain by any practitioner during the 4 months prior to the first clinical encounter with a diagnosis of back pain.”
At first glance, that stipulation may appear to exclude patients who initially saw a physician before being referred to physical therapy. Thankfully, that is not the case. Medicare is merely targeting a more chronic pain patient population who has procrastinated—as many do—before seeking medical attention. In other words, the date of injury or pain onset must be at least four months prior to the patient’s first visit with any medical professional. Although it’s not immediately clear in the above excerpt, you can report on a patient who has already seen another provider—such as a physician or chiropractor—during a particular episode as long as the patient experienced back pain for at least four months prior to seeking any type of medical treatment. Upon seeking treatment for back pain—whether it’s a recurrence of prior pain or an onset of new pain—the first visit to any medical professional triggers the start of a new episode. But if the patient sees both a primary care physician and a specialist (e.g., a PT), both visits are considered the initial visit for each clinician, and both clinicians can report on the back pain measures group for that patient, even though they are treating within the same episode. In fact, further down in the measure specification document, Medicare provides this direction: “If a patient has a four-month period without treatment, and then sees both a primary care physician and a specialist, both visits are considered the initial visit with that clinician.”
Last Wednesday, just before we all headed home to gorge ourselves on turkey and pumpkin pie, Medicare released the Final Rule—all 1,369 pages of it. While it wasn’t exactly light reading, our fearless leader (and speed reader) Heidi Jannenga pored over this hefty document with a mission of finding all the Physician Quality Reporting System (PQRS) information that’s most important to you right now. Below is a breakdown of what you need to know about 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- and registry-based reporting) and start our month-long blog and webinar theme of “everything you need to know to be PQRS compliant.”
Unfortunately, this year is shaping up a little differently. As a result of the government shutdown, CMS delayed its November 1 meeting to discuss the 2014 Physician Fee Schedule Proposed Rule—which includes potential PQRS changes—until at least the middle of this month. And until they meet, we won’t know much about what PQRS 2014 will truly entail in terms of reporting requirements, measures, penalties, and incentives—let alone when the government will actually finalize the Proposed Rule. This means that as of today, no one knows for sure:
- which measures therapists must report
- how many measures therapists must report
- whether there will be compliance incentives
- what penalties will be associated with noncompliance
- what percentage of patients for whom therapists must complete PQRS reporting
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.
Tis the season for PQRS. Why the hullabaloo? Because beginning in 2013, not complying with PQRS requirements will result in penalties, which CMS will assess as fines (starting at 1.5% of your fee schedule) in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period. With the impendency and necessity of PQRS reporting, we’ve dedicated this month to blog posts on all things PQRS.
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 people look at the price and automatically assume claims is the way to go. Not so fast. There are some major cost and workflow considerations when taking on the claims-based beast.