Physician Quality Reporting System

Transcription

1 WELCOME

2 Physician Quality Reporting System

3 Presenter Lisa Chador, MBA Vice President of Sudaco since 2005 Project Manager of EHR Implementations Certified Implementation Specialist with multiple vendors

4 Who is Sudaco? Established 2001 Headquartered in Sarasota, Florida Revenue Cycle Management and Medical Coding servicing Manatee, Sarasota and Charlotte Counties Successfully supporting PQRS / PQRI since the program inception in 2007.

5 PQRI Overview The 2006 Tax Relief and Health Care Act (TRHCA) (P.L ) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries.

6 PQRI Concept Eligible providers select a number of quality measures relevant to their practice and provide responses to each quality measure for a set of Medicare patients. Program operates at the provider level Measures Group (30 Unique Patients) Individual Measures (80% 2010 / 50% 2011 of qualifying patients)

7 is still open Assuming you have filed claims already for 2010 Use a registry Must use a measures group (unless you have very low claim volume.) Deadline is 2/28/2011

8 Measure Groups Select a measure group that applies to your practice. Must report on 30 unique patients. There is an Intend to report code that must be included. Medicare Patients Only Same qualifying criteria for the entire measures group.

9 Diabetes Measures Group Example:

10 Qualifying Criteria Medicare Age, CPT, DX

11 Sample Measure

12 Gotcha s Response Codes must be on same claim with the qualifying CPT and DX code. If you missed, you missed Some measures require multiple response codes to satisfactorily respond. Answer all measures in the measures group to get credit for that patient. Don t forget the intend to report G Code

13 Success Measures Group 30 Unique qualifying patients Successfully respond on all codes If you need 30 successful reports, we recommend doing 50. There is no feedback during the year, so if you ve made a mistake, you won t know except that your check doesn t show up.

14 Individual Measures If you can t find a measures group that applies, pick 3 individual measures. Use the List to get a high level idea of what s there. Use the specification to see the details. There are some practices that will struggle to find rules that apply.

15 Individual Measures Measure Groups are easier, but if you can t find a measures group that applies, pick 3 individual measures.

16 Add l Gotcha s Everything mentioned in the measures group gotcha s. Take notice of whether your rule is per visit or per patient. Each rule designates whether you can report via claims, registry, or EHR. You cannot assume the rules, qualifying DX s, qualifying CPT s, or responses stay the same from year to year. Must read the release notes each year to see if there are changes to your rules.

17 Success If doing individual measures: For 2010, you successfully report on 3 rules per provider for 80% of the eligible patients (or encounters if the rule is encounter based.) For 2011, the threshold is 50%.

18 Reporting Methods Claims Registry EHR

19 Claims Reporting When you submit your claim, add the response code on the same claim. (Not later on a different claim.) Many practices will create a separate checklist for the provider to circle or check the response for each measure and it is entered along with the billing codes. EHR template No charge for this method. Check an EOB to confirm

20 Registry Reporting Utilization of a separate service outside of your claims reporting. Allows you to do the PQRI separate from claims submission. $200 per provider

21 MD Interactive

22 EHR Data Reporting Check with your EHR vendor

23 Group Reporting Option Miscellaneous

24 Tools Proactive Measures Will your system identify qualifying claims for you? Point of Care At Claim Entry Prior to Claims Filing Scorecard Can you get a report card of how you re doing on each measure for each provider?

25 Resources On the right Measures Codes At the bottom Downloads At the very bottom, FAQ s PQRI Feedback reports: Quality Net Helpdesk

26 Bonus Payment Usually arrives end of Sept / Early Oct of the following year. No feedback or communication in between. Your check just arrives. 2% of all MCR reimbursements % of all MCR reimbursements 2011 Per provider

27 E-Prescribe Program is parallel to PQRI Must erx 25 prescriptions during the year. Must report G8553 to signify that you eprescribed.

28 E-Prescribe Worth another 1% of Medicare Reimbursements. Protect your 2012 and 2013 Medicare Reimbursements 10 erx by June 30 or 2012 is reduced by 1% 25 erx by Dec 31 or 2013 is reduced by 1% Cannot participate in both eprescribe and Meaningful Use

29 Q&A Q&A I will be presenting in person at the MMA PHO meeting on March 22.