Medicare Quality Program – 2016 Checklist

 In Articles, Meaningful Use, PQRS, Value-Based Modifiers

Guide to Upcoming Deadlines & Actions To Take Now


EHR Incentive Program (Meaningful Use)

  • All Providers Should Apply for a Hardship Exception for 2015: The application deadline has been extended to July 1, 2016. Even if you attested for MU for 2015, MGMA and the AMA are recommending that all providers also complete a Hardship Exception, checking off box 2.d.d. due to the late release of Modified Stage 2 requirements for 2015. Form and Instructions
  • Monitor Compliance with Modified Stage 2 Requirements: The 2016 reporting period is a full 12 months and we are already 25% of the way through the year. All providers must meet each of the requirements or an exception. One patient must view/download/transmit their data from your patient portal in 2016 (as opposed to the 2015 requirement of function enabled).
  • Public Health Registries: If you missed the March 1 deadline for registering with a “Specialized” Registry, don’t worry. CMS extended the Alternative Exclusion for this measure for 2016.
  • Watch for your bonus payment: CMS deposits this directly in your bank account. No Remittance Advice is sent to the practice. You can log back into the Attestation Website to check payment status.


Value-Based Modifier Program

  • Understand the Details: In 2016, some practices are being paid 32% more on each Medicare claim due to the Value-Based Modifier Program; others are being paid 4% less. Starting in 2015, the program applied to all physician practices, regardless of size or specialty. If you don’t have a clear understanding of how this program works, now is the time to get on-board. Read the details at CMS Physician Feedback website, watch a CMS Video, sign up for a webinar, or get custom advice through MSOC Health’s 2016 PQRS Consulting Package.
  • Get an EIDM Login: The only way to know what you will be paid for Medicare claims in 2017 is to review your 2015 Quality Resource and Utilization Report (QRUR), scheduled for release in Fall, 2016. You’ll need an Enterprise Identify Management Login (EIDM). The process can take 4-6 weeks so we recommend getting started now. User Guide for Obtaining an EIDM
  • Review Your 2014 QRUR Reports: Even if you are not seeing an increase or decrease in Medicare payment rates for 2016, you can use these reports to understand how you compared to the national average back when only 3 quality measures were required.


Physician Quality Reporting System (PQRS)

  • Review results from 2015: What worked well in collecting and reporting quality measures for 2015 and what didn’t? How do your performance rates stack up against the national averages? View 2014 averages here.
  • Understand the changes for 2016 reporting: 3 new Measure Groups were added for 2016; the list of cross-cutting measures expanded; there are many more QCDRs available and you can report as a Group through them. Make sure you check the details for each of the measures you are reporting – definitions, eligibility criteria and instructions can change annually.
  • Make a 2016 Plan: What measures will you report? How will you collect the data? Will you report the data to your Association (QCDR), a Registry, via your EMR or through Claims? Will you report as individual providers or as a Group? How will you educate and get buy-in from your providers and staff?
  • Register for GPRO Reporting by June 30: If you are planning to report as a Group, you’ll need to have an EIDN Login and register on the CMS Portal between April 1 and June 30.  You’ll also need to identify how you will report (EHR, QRDC, Registry or GPRO Website).  If you have over 100 providers and are reporting as a GPRO you will also be required to submit CAHPS for PQRS patient satisfaction data and will need to select your CAHPS vendor.


Need help with Medicare Quality Program requirements? Check out the webinars listed below or use our 2016 PQRS Consulting Package for just $495. Contact Jeanne Chamberlin at 919-442-2422 or  for more information.

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