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Physician Quality Reporting System

Resources to help you to report successfully for the PQRS incentive bonus.

For 2014, CMS continues to tie both penalties and bonuses to participation in PQRS.

  • If you are a Medicare-enrolled provider, there are no exemptions from PQRS participation.
  • Individual reporting is captured by the physician National Provider Identifier (NPI).
  • Every Medicare-enrolled ophthalmologist can participate, no matter their subspecialty training.
  • Practices do not need to have electronic health records (EHR) to report PQRS.
  • There are reporting options for subspecialties in ophthalmology.

IRIS™ Registry will help automate PQRS reporting


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This year, the Physician Quality Reporting System(PQRS) underwent some major changes. Fortunately, the Academy’s IRIS™ Registry (Intelligent Research in Sight) can make it easier for you to meet the program’s reporting requirements for getting the bonus and avoiding the penalty.


Bonus or Penalties

Physicians who successfully participate in PQRS in 2014 will achieve a 0.5 percent bonus on all their Medicare Part B, Medicare as a Secondary Payer, and Railroad Medicare allowables, less durable medical equipment and any injectable drug, for dates of service between Jan. 1 and Dec. 31, 2014.

Physicians who choose not to participate in 2014 will be subject to a 2 percent penalty on all their 2016 Medicare Part B, Medicare as a Secondary Payer, and Railroad Medicare allowables, less durable medical equipment and any injectable drug. This 2 percent is in addition to the 2 percent sequestration annual cut.

Practices with 10 or more eligible professionals not participating in PQRS will be subject to a third 2 percent penalty due to the value-based modifier rules in 2016.


How the IRIS Registry Can Reduce the Burden of PQRS Reporting

The IRIS Registry is the nation’s first comprehensive eye disease clinical data registry. It can reduce the burden of PQRS reporting whether or not you have an EHR system. If you have an EHR system, you can also take advantage of the IRIS Registry’s other functions, such as outcome evaluations and benchmark reports to help improve patient care. The American Academy of Ophthalmology developed the IRIS Registry as part of the profession’s shared goal of continual improvement in the delivery of eye care.

Who can participate in the IRIS Registry? U.S.-based Academy members.

How much does it cost? The Academy is initially offering multiyear, fee-free access to those who sign agreements and meet the data-submission requirements in 2014.


How to Join the IRIS Registry

  • 1.  Visit www.aao.org/irisregistry.
  • 2. Click on the “How to Sign Up for the IRIS Registry” link
  • 3.  Fill out a questionnaire.
  • 3. Review and sign the agreements. Next, you will be placed on a reservation list in order of receipt of the signed agreements and questionnaires.
  • 4. When it’s your turn for set-up, you will be sent an e-mail asking you to download the software and integrate it with your database. The IRIS Registry team will confirm connectivity and begin mapping.

All U.S.-Based Members Can Participate in IRIS Registry

The IRIS Registry is available to all U.S.-based Academy members and their practices. Eligible physicians can report 2014 clinical quality data to both PQRS and the Medicare Electronic Health Record Incentive Program if they meet reporting requirements and signed a participation agreement before the June 1 deadline. For EHR users, the IRIS Registry will automatically extract and submit data for PQRS measures to CMS on a practice's behalf. This eliminates the need to manually report on Medicare claims throughout the year. Academy members who did not sign up by June 1 can instead use the IRIS Registry to manually report claims. Members must sign an agreement to participate in the IRIS Registry by Aug. 1 if submitting the cataract measure group. The deadline is Oct. 31 for members submitting nine individual measures.

Members who sign an agreement and integrate their EHR system with the IRIS Registry in 2014 qualify for multi-year, fee-free access. For more information, including frequently asked questions, webinars, videos and sign-up details, visit www.aao.org/irisregistry.


IRIS Registry Gains Medicare Designation as a Qualified Clinical Data Registry

The Centers for Medicare and Medicaid Services has named the IRIS™ Registry as a Qualified Clinical Data Registry (QCDR). Launched earlier this year, the IRIS (Intelligent Research in Sight) Registry is the Academy’s new eye disease and condition database. It is the nation's only comprehensive, longitudinal ophthalmic database, which helps ophthalmologists streamline the work required to comply with federal payment programs while identifying ways to enhance quality of care and practice efficiency. Congress established the QCDR designation as a mechanism to allow specialists to lead quality measurement. The IRIS Registry is also a qualified registry for the Physician Quality Reporting System.

Members can use the IRIS Registry to collect and report clinical data for PQRS, as well as for the cataract measure group. The QCDR designation also enables specialties to design, implement and report non-PQRS quality measures that are more meaningful to ophthalmic practices and their specific patient populations.

There currently are limited reporting measures available for ophthalmology, particularly for subspecialties including oculoplastics, neuro-ophthalmology and refractive surgery. The new QCDR-reporting option provides ophthalmologists who participate in a registry with an alternative to receive PQRS incentive payments and avoid future program penalties. Beginning in 2015, CMS will penalize physicians who did not satisfactorily report on quality measures for 2013 covered professional services.


Options to Achieve the Bonus

Ophthalmologists have three options to achieve the 0.5 percent bonus payment.


Option 1: Report the cataracts measures group via the IRIS Registry or other qualified registry.

Ophthalmologists may report the cataract measures group on 20 cataract surgical cases they perform up through Sept. 30, 2014 via the IRIS Registry.

Of the 20 cataract surgeries, a majority (at least 11) must be Medicare Part B patients. The remaining cases can have commercial insurance. Patients will be provided preoperative and postoperative surveys to be returned to the IRIS Registry for collation and scoring.

For additional details, see measures 191, 192, 303, and 304.


Option 2: Report nine measures in three quality domains via the IRIS Registry or claims.

You can do this in three ways.

A. IRIS Registry reporting without an EHR

Ophthalmologists are fortunate to have 15 measures that they can potentially report without an EHR. All 15 measures can be reported via the IRIS registry. Ophthalmologists should enroll with the IRIS Registry, then identify which nine of the 15 measures to report.

Physicians without an EHR system can manually enter their data through the IRIS Registry’s online portal. While this method is more labor intensive than the EHR-based approach, it does not involve the real-time entry that claims reporting requires.

Note: What if physicians, based on their patients’ medical needs, don’t have nine measures to report? Physicians may be subject to the CMS measure applicability validation process to make sure they are reporting all applicable measures.

B. IRIS Registry reporting with 2014 Certified EHR Technology while reporting for meaningful use

The IRIS Registry has the capability of integrating with EHR systems to extract data needed to report on clinical quality measures for meaningful use, which can also meet PQRS requirements for 2014. Providers must upgrade to 2014 Certified EHR Technology during the year to report via this method.

C. Claims reporting

Ophthalmologists who report via claims must do so in real time and can’t report on the registry-only measures. They must select nine measures across three quality domains to report via claims.

Physicians who have historically been successful with claims reporting may want to continue to report by this method by adding six additional measures.

Note: Physicians who have been unsuccessful with claims reporting or have never participated in PQRS should strongly consider reporting via the IRIS Registry.

Note: What if physicians, based on their patients’ medical needs, don’t have nine measures to report? Physicians may be subject to the CMS measure applicability validation process to make sure they are reporting all applicable measures.

Claims

  • 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.

CMS 1500 Form Examples


Option 3: Group Reporting

Ophthalmologists who practice in a multi-specialty group with specialties outside of ophthalmology may use the group practice reporting option. In this case, reporting is by the group practice’s tax identification number (TIN) rather than the individuals’ NPIs. Details can be found at www.cms.gov.


Successful Reporting

Each individual ophthalmologist must report on at least 50 percent of eligible Medicare patients in order to be eligible for the incentive bonus through either claims, IRIS Registry reporting with EHR, or IRIS Registry online portal reporting. Alternatively, you can report the cataracts measures group for 20 patients.


Avoiding the Penalty

The old standard to earn a bonus became the standard to avoid the penalty. In order to avoid the 2 percent 2016 penalty, each physician must successfully report three measures during the Jan. 1 to Dec. 31 reporting period. Report the three measures via claims, IRIS Registry reporting with EHR, or the IRIS Registry online portal.


Quality Domains

Here are the six quality domains, along with the measures for each domain that are most relevant to ophthalmology. Note that some measures can only be reported by a registry, not claims.

  • Patient safety: measures 130 and 192 (registry only)
  • Communication and care coordination: measures 138 (registry only), 141 and 265 (registry only)
  • Efficiency: measure 224 (registry only)
  • Clinical process and effectiveness: measures 12, 14, 18, 19, 117, 137 (registry only), 140, 191 (registry only) and 303 (cataracts measures group)
  • Population health: measure 226
  • Patient and family experience: measure 304 (cataracts measures group)


View all Measures by Specialty.


Additional Resources

Questions may be emailed to pqrs@aao.org.


Disclaimer and Limitation of Liability

All information provided by the American Academy of Ophthalmology, its employees, agents, or representatives who participate in the Academy’s coding service is based on information deemed to be as current and reliable as reasonably possible. The Academy does not provide legal or accounting services or advice, and you should seek legal and/ or accounting advice if appropriate to your situation. Coding is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that either public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from any such information provided by the Academy, its employees, agents or representatives. The Academy’s sole liability for any claim connected to its provision of coding information or services shall be limited to the amount paid by you to the Academy for the information or coding service.

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