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New Measure Specs in PQRS Updates for 2014

January 24, 2014:

Nannette Orme, CPC, CCS-P, CPMA, CEMC Clinical/Technical Editor

The update to the 2014 Physician Quality Reporting System (PQRS) Claims/Registry Measure Specifications Manual includes specific information on the physician payment adjustment, as well as new examples of measure specifications for 2014. The update also includes information on those eligible professionals (EP) who report on an individual basis.

The update was released on December 13, 2013.

The manual incorporates revisions to the reporting criteria for using the group practice reporting option (GPRO). Providers must satisfactorily meet the 2014 reporting requirements to qualify for a 0.5 percent incentive payment and must also meet the reporting threshold to prevent a negative 2.0 percent payment adjustment in 2016.

Additionally, it should be noted that CMS is basing the value-based payment modifier (VBPM) reimbursement methodology on successful PQRS reporting. For 2014, the agency is establishing a two-category quality tiering to evaluate performance on quality and cost measures for the value-based payment modifier. Under this new system, groups of physicians with 100 or more eligible professionals would receive an upward, neutral, or downward adjustment. Also for 2014, groups of 25 or more EPs could participate in the program. Failure to participate in the VBPM in 2014 could result in a negative 1 to 2 percent reduction in Medicare payment, depending on the classification of the group (i.e., low quality/high cost, low quality/average cost or average quality/high cost).

The release notes document lists the changes to numerator and denominator codes specific to a measure. The release notes also include new measures added for 2014:

  • Adult kidney disease—two new measures
  • Adult sinusitis—four new measures
  • Maternity care—two new measures
  • Tuberculosis prevention for patient on a biological immune response drug—one new measure
  • HIV—two new measures
  • Pain control—one new measure
  • Screening colonoscopy—one new measure
  • Carotid artery stenting (CAS)—two new measures
  • Endovascular aneurysm repair (EVAR)—one new measure
  • Implantable cardioverter-defibrillator (ICD)—one new measure
  • Optimal vascular care composite—one new measure
  • Patient-centered surgical risk assessment—one new measure

It is critical to keep up-to-date on the PQRS changes to avoid reimbursement penalties beginning in 2014.


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