PQRS

PQRS Measures by Specialty (2016)

The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

PQRS Measures for Behavioral Health (2015)

Performance Measurement Codes for Behavioral Health:

PQRS Measures for Behavioral Health (2014)

Performance Measurement Codes for Behavioral Health:

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In short, MIPS is the new Medicare payment incentive/penalty system which will begin in 2019. The Medicare Access and CHIP Reauthorization Act of 2015 (also known as the SGR repeal or 'doc fix') included the creation of a new pay-for-performance program called the Merit-Based Incentive Payment System (MIPS). In 2019, MIPS will replace the current PQRS, EHR, and VBM as we know it now.

Due to an error found in the logic, The Centers for Medicare & Medicaid Services (CMS) is providing guidance relating to measure CMS122 (Diabetes: Hemoglobin A1c Poor Control) included in the 2014 measure set for the Electronic Health Record (EHR) Incentive Program for Eligible Professionals. Version CMS122v3 of the measure was posted on CMS’s website on May 30, 2014. A subsequent posting of this measure in 2015 (CMS122v4) resolved this issue for the 2016 program year. 

Background

CMS is extending the 2014 Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on December 11, 2015 to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of November 23, 2015.  

As you know, the PQRS (Physician Quality Reporting System) includes the reporting of particular G codes to communicate with Medicare, details of the Functional Outcome Assessment and Pain Assessment and Follow-Up measures. These measures must be completed on at least 50% of an eligible professional's active patients to avoid penalty.

Recently, letters have been sent out to practices informing practices that they have not satisfactorily reported those PQRS measures and therefore, a negative payment adjustment (penalty) will be assessed from 2016 Medicare reimbursements.

CMS will begin to apply a negaitive payment for 2014 PQRS

By:  Chris Woolstenhulme, CMRS
Published: September 29th, 2015

Here we go, CMS will begin to apply a negative payment adjustment to EP’s (Eligible Professionals) that did not participate and satisfactorily report Physician Quality Reporting System (PQRS) in 2014. Remember, the program participation during a calendar year will affect your payments in two years. Therefore; if you do to successfully report in the year 2015 you will be penalized in 2017.  

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