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2014 PQRS Frequently Asked Questions

The following represent the frequently asked questions submitted by Academy and AAOE members to pqrs@aao.org (as of Jan. 7, 2014). This page is updated on a regular basis.


Q: Have the measures changed in 2014 from 2013?
A: No. The measures are the same for 2014 as they were for 2013.

Q: I do not understand the term "domains." In 2013, we reported four measures by claims reporting. Does this mean we will have to report nine measures now?
A: "Quality domains" is a new term for 2014. There are six.

  1. Patient safety - two ophthalmic measures
  2. Communication and care coordination - three ophthalmic measures
  3. Efficiency - one ophthalmic measure
  4. Clinical process - eight ophthalmic measures
  5. Population health - one ophthalmic measure
  6. Patient and family experience - none that are ophthalmic specific

In order to earn the 0.5 percent bonus, physicians must report nine of the possible 15 measures from three quality domains. You must accurately report 50 percent of the time. This can be reported via claims or registry.

Q: What if I don’t see patients who represent nine measures? Can I report fewer measures and still qualify for the incentive payment?
A: Yes. Just be prepared for a measure applicability validation to ensure you’ve reported on all available measures. CMS describes the validation process in a document included in the Claims Measure Application Validation zip file at the bottom of its Analysis and Payment page. Once you download the zip file, open the "MAV Process for Claims" PDF.

Q: I am a retina specialist. What nine measures can I elect to report?

  1. Documentation of current medication in the medical record
  2. POAG documentation of a plan of care
  3. POAG optic nerve evaluation
  4. ARMD dilated exam
  5. DR documentation of presence or absence of macular edema and level of severity of retinopathy
  6. DR communication with physician managing ongoing care
  7. ARMD counseling on antioxidant supplement
  8. DM dilated exam
  9. Tobacco use

Q: When will we be required to submit ICD-10 diagnosis codes instead of ICD-9 codes?
A: The date ICD-10 is launched: Oct. 1, 2014. View AAOE's ICD-10 checklist.

Q: We are a one-doctor practice without any plans to get EHRs. Will we be required to have EHRs to report PQRS in 2014?
A: Reporting though an EHR system is only one of the options for reporting PQRS. However, the EHR must be certified according to CMS' 2014 standards. Claims and registry reporting are also options.

Q: Can we choose to report PQRS through claims and a registry?
A: Yes. CMS will give credit to the reporting method that is most accurate.

Q; When should we use a modifier when reporting PQRS?
A: Each measure is associated with modifier(s). For example, there are 2 modifiers that apply to measure 12 POAG optic nerve evaluation:

  • 1P documentation of medical reason(s) for not performing an optic nerve head evaluation; or
  • 8P Optic nerve head evaluations was not performed, reason not otherwise specified.


When the physician evaluates the optic nerve, Category II code 2027F is reported. When the physician evaluates the same patient at a subsequent visit and it is not medically necessary to repeat the optic nerve evaluation, 2027F 1P is submitted.

Q: If I choose not to achieve the incentive payment, but just avoid the penalty, what do I need to do?
A: What practices had to do to achieve the bonus in previous years is what they will have to do in 2014 to avoid the 2 percent penalty in 2016.

Report three measures via claims correctly at least 50 percent of the time from Jan. 1 through Dec. 31.

Physicians are strongly encouraged to earn 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.

 

Visit www.aao.org/pqrs for complete details on the 2014 Physician Quality Reporting System.