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Medical Coding News Archives

Upcoming 2012 Changes for Physician Incentive Programs

 
December 6, 2011:

Karen M Adkins, Clinical/Technical Editor

The final rule on physician payment released on November 1, 2011, includes an expansion of the incentive programs associated with Medicare physician fee schedule (MPFS) payments to include electronic health records (EHRs) and the Physician Quality Reporting System (PQRS), and clarifies the Physician Compare tool.

Electronic Health Records Incentive Program:
Effective January 1, 2012, eligible professionals (EPs) will be required to submit clinical quality measures (CQMs) results electronically via certified EHRs. In July 2010, the final rule that instituted this program also required that the primary method for providers to report CQMs be through a CMS-designated portal and upload process. The following methods are available for reporting CQMs:

  • Maintain the current attestation process for reporting CQMs
  • Partake in a PQRS-Medicare EHR incentive pilot program (established in the 2012 final rule) whereby EPs can report CQMs by one of two means:
    • via a PQRS-qualified EHR data submission vendor
    • via a secure portal directly from the provider’s own EHR

If using the first method, the vendor will submit calculated results from the provider’s EHR system to CMS on behalf of the EP. In both options, the EHR must be a qualified PQRS EHR product.

Physician Quality Reporting System
The final rule established the following changes for the PQRS in 2012:

  • Group practice reporting option (GPRO) definition and criteria changing to reflect 25 or more individual EPs
  • 29 measures confirmed for reporting under PQRS GPRO
  • 26 new measures included for 2012 (211 total individual measures)
  • Addition of a PQRS core measure set consisting of seven measures for preventing cardiovascular conditions
    • one for EHR reporting only
  • Maintenance of the current 44 EHR measures
  • Eight new measures groups (23 total measures groups):
    • cardiovascular prevention
    • COPD
    • inflammatory bowel disease (IBD)
    • sleep apnea
    • dementia
    • Parkinson’s disease
    • elevated blood pressure
    • cataracts

Physician Compare Website
As required under the Affordable Care Act (ACA), the final rule indicates that the Centers for Medicare and Medicaid Services (CMS) will begin reporting performance rates for group practices who submitted data under the PQRS GPRO reporting option in 2012. Performance rates from other CMS demonstrations using group practice reporting on the Physician Compare website will begin in early 2013.

 

 
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