Ideally, the only responsibility of a physician is to provide the best care to his/her patients. Unfortunately, medicine is a business, so the topic of reimbursement will always rear
its ugly head.
Providers of Part B services on the MPFS can increase reimbursement and avoid future penalties by taking advantage of Medicare incentives for EHR and PQRS reporting. Below you will find guidance on
both of these programs to help improve your bottom line.
To qualify for Medicare PQRS incentive payments, EPs must sufficiently report on the applicable quality information measures. In the PQRS 2013 program, there are several hundred measures.
To help navigate through this complex process, you can access the “Getting Started” page of the CMS PQRS website by clicking here.
Advanced Practice management software like Iridium Suite, has an integrated PQRS claim scrubber. The practice can configure the medical billing system to automatically request that the physician sets up PQRS measures for each patient. The claim scrubber also recognizes which billing codes are potential PQRS denominators and automatically suggests the PQRS numerator codes that should be added to the claim. The biller simply accepts these suggestions and the claim scrubber automatically adds the proper PQRS charge codes to the claim.
To qualify for the Medicare EHR incentive payments eligible professionals (EPs) must utilize certified meaningful use EHR technology. Proof of meaningful use can only be demonstrated by reporting clinical quality measures (CQMs) as well as the meaningful use measures.
Providers wishing to purchase certified EHR software can access a list of options on the CMS site by clicking here.
In 2013, EPs may satisfy the meaningful use objective to report CQMs to CMS by reporting them through:
- Medicare and Medicaid EHR Incentive Programs’ web-based Registration and Attestation System
EPs who choose to report CQMs through the CMS Attestation system must still report information on individual quality measures or measure groups using one of the four reporting options in order to also participate in PQRS.
- Participation in the PQRS-Medicare EHR Incentive Pilot, which utilizes the 2013 PQRS EHR Measure Specifications.
EPs who participate in the pilot may submit their meaningful use objectives through the CMS Attestation system, and then complete a single submission of CQMs to receive credit for both programs.
EPs who successfully participate in PQRS and EHR can receive an incentive in 2013 and avoid the 2015 payment adjustment for both programs.
Participating in both the PQRS and EHR programs in 2014 and beyond is being simplified by CMS with the alignment of several of key components.
Here are the changes affecting PQRS and EHR in 2014:
- PQRS and EHR programs will align on the same set of eCQMs (64 total) and the same electronic specifications
- All Medicare-EPs beyond their first year of demonstrating meaningful use will be required toelectronically report their CQM data to CMS for the EHR program
- Submitting data electronically using 2014 certified EHR technology will meet the standards forboth EHR and PQRS programs
- Participating EPs will have the option to submit patient-level data (via QRDA I) or aggregate data (via QRDA III) using the same reporting mechanism for electronic reporting for both programs.
Click here to read about how your EHR can communicate with your medical billing software.