For 2014, CMS continues to tie both penalties and bonuses to participation in the Physician Quality Reporting System.
- To avoid the 2 percent penalty on 2016 Medicare payments, physicians must report three PQRS measures.
- To receive a 0.5 percent bonus payment, physicians must report nine measures in at least three of the new national quality strategy domains or report the cataract group measures.
- Physicians who cannot meet the bonus requirement may report on fewer measures and/or domains. However, CMS will review such submissions to ensure that more measures do not apply.
! IRIS™ Registry will help automate PQRS reporting
CMS made several key changes for 2014.
- The old standard to earn a bonus became the standard to avoid the penalty.
- CMS also assigned all measures to one of six new quality domains. See how the domains apply to ophthalmology.
- To earn the bonus, physicians must meet both a measure and a domain minimum.
|Amount of future penalty
||1.5 percent in 2015
||2 percent in 2016
|Threshold to avoid penalty
||Report one PQRS measure one time.
||Correctly report three measures at least 50 percent of the time via claims or qualified registry.
|Amount of bonus
|Requirement to earn bonus
||Report three measures or report the cataract measure group for 20 patients.
||Report nine measures in at least three of the new domains or report the cataract group measures for 20 patients.
How to Avoid the 2016 Penalty
As in 2013, CMS will use 2014 reporting to determine future penalties. Practices that don't successfully meet the minimum-reporting require ments for 2014 will receive a 2 percent penalty on 2016 Medicare reimbursements. The penalty would be in addition to the 2 percent cut already in place as a result of sequestration, the federal government’s across-the-board cuts in government spending.
- To avoid the penalty, physicians must correctly report three measures via claims at least 50 percent of the time, Jan. 1 to Dec. 31. Note: This means that practices must meet the reporting standard for bonuses in previous years just to avoid the future penalty for 2014.
- Physicians are strongly encouraged to achieve the PQRS incentive payment, not necessarily due to the bonus itself, but to avoid the penalty and subsequently avoid having a negative value-based modifier applied to their 2016 Medicare payments.
How to Get the 2014 Incentive
To earn the 0.5 percent incentive payment for 2014, physicians must choose one of three reporting options and meet the applicable reporting minimum (see below).
- Report the cataract group measures; OR
- Register to report as a group practice (not ophthalmology specific); OR
- Individually report nine measures in three quality domains, using the method of your choice (options described below). Note: If less than nine of the measures reflect your patient base, you may report fewer. However, CMS will assess your reporting to ensure you’ve reported on all measures possible.
CMS calculates incentive payments based on all Medicare Part B, Medicare as a Secondary Payer and Railroad Medicare allowable less injectable drugs or durable medical equipment. Bonus payments are subject to the 2 percent sequestration penalty.
Ways to Report
Only those reporting by registry can choose the cataract measure group option. For all other measures, groups and individuals can choose among claims, registry or EHR reporting. Groups can also report by "Web Interface."
- Choose measures that represent your patient base, rather than your specialty training.
- For all options except the cataract measure group, the reporting period is Jan. 1 to Dec. 31.
- Whether reporting to avoid the penalty or earn the incentive, you must report correctly at least 50 percent of the time. You should report every case, as you won't know until the end of the year if you reported correctly.
- Historically, those reporting by registry had the highest success rate.
- Submit measures on the same CMS 1500 form as the associated exam.
- Link diagnosis codes to the exam as well as to the measure. If the exam is denied, the measure will be denied also. Both must be resubmitted.
- While CMS does not require a charge fee, your system may require a fee to release the claim. Therefore put 1 cent in the charge field.
- Watch the remittance advice for N365 or C096 to assure the PQRS measure(s) was accepted.
- Submit data to the Academy's IRIS Registry or a CMS-qualified registry. Unlike claims-based reporting, registry reporting does not have to be submitted in real time.
- Those who've never successfully reported for PQRS in the past are more likely to succeed via registry reporting.
- Submit data through an EHR system that's been certified by CMS' 2014 standards.
- If you report your nine measures in three quality domains through an EHR enrolled in the Academy’s IRIS Registry, you can simultaneously qualify for the Medicare EHR incentive program's stage 2 clinical quality measures.
Cataract Measure Group
- Reporting period: Approximately April or May (as it takes CMS time to qualify the registry ) through Sept. 30.
- Report 20 surgical cases, at least 11 of which must be Medicare Part B patients. The remaining may have commercial or Medicare Advantage Plan coverage. View cataract measures.
- Submit data to either the IRIS Registry or a qualified CMS registry.