EyeNet Magazine


 
Savvy Coder: Coding & Reimbursement
What You Need to Know About Quality Reporting for 2014
By Flora Lum, MD, Executive Director, H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care, Academy Policy Director, Quality of Care and Knowledge Base Development; Cherie McNett, Academy Director of Health Policy; and Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
Academy members: login to read or make comments on this article.
 
(PDF 49 KB)

This year, the Physician Quality Reporting System (PQRS) program undergoes some major changes. Here’s a quick overview of how you can avoid the penalty and receive the bonus. (For a more detailed guide, visit www.aao.org/pqrs.)

Physicians who fail to participate in PQRS in 2014 will be subject to a 2 percent penalty in 2016 of all their Medicare Part B, Medicare as a Secondary Payer, and Railroad Medicare allowables. Those who report successfully will receive a 0.5 percent incentive payment in the fall of 2015.

Reporting Options

How to avoid the penalty. Last year, you had to report one measure at least once to avoid the penalty. This year, you must correctly report three measures via claims at least 50 percent of the time from Jan. 1 through Dec. 31.

How to receive the incentive payment. You can:

  • Report the cataract group measure on 20 patients, or 
  • Register to report as a group practice, or 
  • Report nine measures in three quality domains 50 percent of the time. You can report fewer than the required number of measures or measures in fewer than three quality domains, but you will be subject to measure applicability validation to ensure that you’ve reported on all available measures. Note: If you report your nine measures in three quality domains through your electronic health records to the Academy’s IRIS Registry, you can qualify for the Clinical Quality Measures in meaningful use Stage 2 at the same time (www.aao.org/irisregistry).

Top

Quality Domains and Measures

Here are the measures most relevant to eye care, listed by quality domain.

Patient Safety domain:

  • Cataracts: Complications within 30 days following cataract surgery requiring additional surgical procedures. (Registry and EHR reporting only.) 
  • Documentation of current medications in the medical record.

Communication and Care Coordination domain:

  • Biopsy follow-up. (Registry only.) 
  • Primary open-angle glaucoma: Reduction of IOP by 15 percent or documentation of a plan of care. 
  • Melanoma: Coordination of care. (Registry only.)

Efficiency domain:

  • Melanoma: Overutilization of imaging studies. (Registry only.)

Clinical Process and Effectiveness domain:

  • Primary open-angle glaucoma: Optic nerve evaluation. 
  • Age-related macular degeneration: Dilated macular examination. 
  • Diabetic retinopathy: Documentation of presence or absence of macular edema and level of severity of retinopathy. 
  • Age-related macular degeneration: Counseling on antioxidant supplement. 
  • Diabetic retinopathy: Communication with the physician managing ongoing care. 
  • Diabetes mellitus: Dilated eye exam in diabetic patient. 
  • Melanoma: Continuity of care—Recall system. (Registry only.)
  • Cataracts: 20/40 or better visual acuity within 90 days following cataract surgery. (Registry and EHR reporting only.)

Population Health domain:

  • Preventive care and screening: Tobacco use—screening and cessation intervention.

Patient and Family Experience domain: None apply specifically to eye care.

Top

Getting Started 

Select measures (www.aao.org/pqrs) that represent your patient base, then:

  • Decide if you just want to avoid the penalty or also get the incentive,
  • Determine if you will participate as an individual or a group,
  • Determine if you’ll report via claims, registry, or EHR, or
  • Report the cataract group measure through a registry.

Questions? E-mail pqrs@aao.org.

Top


Academy members: login to read or make comments on this article.
About Us Academy Jobs Privacy Policy Contact Us Terms of Service Medical Disclaimer Site Index