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Medical Coding News Archives

CMS to Up Quality Reporting Requirements for Some Providers

 
July 18, 2013:

Deborah Hall, Clinical/Technical Editor

The Centers for Medicare and Medicaid Services is proposing to increase the requirements for reporting individual measures of quality data through the claims-based and registry-based options. The details are included in the Medicare physician fee schedule proposed rule for 2014, to be published in the Federal Register on July 19.

Currently the provider has two options when using claim-based reporting: report at least three measures; or when fewer than three measures apply, report one to two measures AND report each measure for a minimum of 50 percent of eligible patients seen during the reporting period. Under CMS’s proposal for 2014, providers would have to report AT LEAST nine measures or, when fewer than nine measures apply, report one to eight measures for at least 50 percent of the Medicare patients seen during the reporting period.

The agency goes on to state: ”We note that this proposal would increase the number of measures an eligible professional is required to report via the claims-based reporting mechanism from 3 measures to 9. We understand that this is a significant increase in the number of measures an eligible professional is required to report. However, we believe that the need to collect enough quality measures data to better capture the picture of the care being furnished to a beneficiary, especially when this data may be used to evaluate an eligible professional’s quality performance under the value-based payment modifier, justifies the increase in measures.”

CMS proposes a similar increase in the number of measures that must be reported for those providers reporting quality data through a registry. Currently, providers using the registry must report at least three measures AND each measure for at least 80 percent of the eligible patients seen during the reporting period to which the measure applies. CMS proposes changing this criterion for individual eligible professionals for the 12-month reporting period to reporting at least nine measures covering at least three of the National Quality Strategy domains AND reporting each measure for at least 50 percent of the eligible professional’s Medicare Part B fee-for-service patients seen during the reporting period to which the measure applies. Again, the agency indicates that the increase is necessary to obtain enough quality measure data to evaluate the provider’s quality performance under the value-based payment modifier.

Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin using a value modifier under the Medicare physician fee schedule (MPFS) so that both cost and quality data could be included in calculating payments for physicians. Under these regulations, physician groups of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number will be subject to the value modifier in 2015, based on their performance in calendar year 2013. All payment to physicians participating in the Medicare fee-for-service program will be affected by the value modifier beginning in 2017.

 

 
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