October 2015 Update on Medicare Quality Programs: MU, PQRS and VBM
2014 Reporting Period
(Penalties in 2016)
- CMS has published feedback reports on PQRS quality measures reported for 2014. If you received a 2014 PQRS incentive payment in July/August, you will not receive a penalty in 2016. We recommend you check the penalty status for each provider using these instructions. If you disagree with CMS’s assessment, you must file an informal review request by November 9, 2015.
- CMS has released Quality Resource and Utilization Reports (QRUR) for the 2014 reporting period. These reports provide details on how you compare to your peers on cost and quality and for practices with 10 or more providers and determine the Value-Based Modifier bonus/penalty you can expect in 2016. Accessing and reviewing QRUR reports is complicated. CMS instructions can be found here. Or, join the webinar on October 20, 2015, from Audio Educator to learn more.
- The 30-day preview period for quality measures that will be released to the public on the Physician Compare website began October 5, 2015. Data is published only for group practices who reported through the GPRO Website and individual providers who reported on specific measures through claims. Find more details here.
2015 Reporting Period
(Penalties in 2017)
- MU Modified Rules: At long last, CMS has issued its final rule on Meaningful Use (MU) for the 2015 reporting period. There were just a few minor modifications to the proposals published in April, with the result that 2015 requirements are significantly reduced for all providers. Click here to learn what you need to know.
- PQRS and VBM: If you have not yet made a plan for reporting quality measures for PQRS, you’ll want to move forward quickly. Although you have until February/March of next year to report, the data will reflect services provided/documented in 2015. Most providers are required to report nine measures on at least 50% of eligible patients seen during 2015 in order to avoid a penalty of up to 6% on Medicare payments in 2017. At least one patient must meet the quality criteria for each measure. MSOC Health offers a customized consulting package for just $495 that will help you understand and meet the requirements of these programs.
Have questions about any of the Medicare Quality Programs? Contact Jeanne Chamberlin at 919-442-2422 or firstname.lastname@example.org.
Instructions for Verifying 2014 PQRS Penalty Status
Navigate to the website QualityNet website.
Page down to the section at the PQRS Lookup section at the bottom left. Use the drop down to identify the appropriate entity (usually PQRS Eligible Professional); enter your practice’s TIN and the providers NPI number and click Lookup Button. The system will return a statement (shown in bold below) regarding this provider’s status for 2014 PQRS bonus and 2016 PQRS penalty.
To access the feedback report for individual providers who submitted PQRS measures, navigate to the CMS website. Page down to the section titled “Physician Value” and click the “Get Started” button.
Under the section labeled About PV click on PQRS Feedback Reports (do not click the Feedback Reports Button – this will ask you for a login and take you to the QRUR reports).
On the following screen you will be able to enter your name, practice name, address, phone, TIN and provider’s NPI number – select 2014 report year and PQRS Individual Feedback Report type. After clicking Submit, you will immediately be allowed to download a PDF copy of the provider’s feedback report. You must request a separate report for each provider in your practice.