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January 25, 2018

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Medical Coding News Archives

What does PQRS spell? …Headache!

May 10, 2016:

No practice management issue is as complex as the Physician Quality Reporting System (PQRS) for the Medicare program, and no other initiative has such a stiff fine for non-compliance – namely, a 2 percent negative payment adjustment applied to all of the individual eligible professional’s or group practice’s Part B covered professional services under the Medicare Physician Fee Schedule (MPFS).

For 2016, the PQRS has added 37 new measures to the growing list of individual quality measures as well as three new measures groups bringing the total to 25 measures groups. Additionally, the various reporting mechanisms can be complex depending on whether they are reportable via claims, registries, measures groups or via the use of certified electronic health record technology (CEHRT), not to mention whether the measure is reportable only by an individual EP or for group practices. To further add to the confusion, how many times a quality indicator must be reported varies by the quality measures specifications which can also include age and/or gender, or place of service restrictions. Mix in the additional requirement to append exclusion modifiers (when applicable), coupled with the knowledge that mistakes will bring a big financial impact – and we have a tremendous headache on our hands.

The remedy for this headache is the 2016 edition of the Physician Quality Reporting Guide. This manual brings together vital information about each quality measure, helping providers to choose the most appropriate measures for their practice. But beyond the official rules and data, this guide includes customizable worksheets for every quality measure, which ensures the appropriate information for each encounter is captured. That’s a very big part of the battle.

For more information about the 2016 Physician Quality Reporting Guide, visit https://www.optum360coding.com/Product/44907/.


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