Physician Quality Reporting System (PQRS)
An Introduction for Reporting the Dementia Measures Group
This content was gathered from the Centers for Medicare and Medicaid Services website as a service to assist and educate neuropsychologists about the Physician Quality Reporting System (PQRS). This content is neither original nor comprehensive. The information contained in this document is intended to be informative and does not supersede CMS (Medicare), APA or state/provincial licensing boards’ ethical guidelines and/or local, state, provincial or national regulations and/or laws. The Centers for Medicare and Medicaid Services’ website (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html) “serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for the Physician Quality Reporting.” The information contained herein is meant to provide practitioners as well as health care institutions involved in psychological services with the latest information available to the Professional Affairs and Information Committee (PAIC) regarding the issues addressed. Practitioners assume sole responsibility for educating themselves on this issue. The ultimate responsibility of the validity, utility and application of the information contained herein lies with the individual and/or institution using this information and not with NAN, the PAIC, or the author(s) of this document. Note that the Dementia Measures Group and CPT system are copyrighted and the information contained should be treated as such. CPT manuals may be ordered from the AMA at 1.800.621.8335.
Questions about PQRS should be directed to the QualityNet Help Desk – Available Monday – Friday; 7:00 AM–7:00 PM CST; Phone: 1-866-288-8912.
The Physician Quality Reporting System (PQRS) is a reporting program for professional services for Part B Medicare beneficiaries. PQRS is CMS’ foray into pay-for-performance and is the first step in implementing a value-based purchasing pay-for-performance program. It began in 2007 as a financially incentivized voluntary program aimed at advancing quality and efficiency in health care. Psychologists are considered eligible professionals to participate in this program. Reporting PQRS measures was initially voluntary with financial incentives for participation. Inventives are now shifting, so that penalities for not reporting will begin to be implemented in 2015 for eligible professionals who do not report PQRS measures starting in 2013. Eligible professionals receiving a payment adjustment in 2015 will be paid 1.5% less than the Medicare Physician Fee Schedule (MPFS) amount for that service. To avoid the 2015 PQRS payment adjustment, individual eligible professionals will have to satisfactorily report data on quality measures for covered professional services provided in 2013. Clinical psychologists and neuropsychologists are eligible to participate. One may choose to report information on individual PQRS quality measures or measures groups. Most applicable to neuropsychologists are the dementia measures, which must be reported as a group. It is advisable to select measures or groups of measures to report that you will have the highest percentage to meet based on your practice population. For claims-based submissions of a measures group, one must report for a minimum sample of 20 unique Medicare Part B fee for service (i.e., individually billed claims) patients who meet patient sample criteria. For claims-based submission of individual measures one must report at least three measures for at least 50% of eligible patients. For registry-based submissions of individual measures one must report at least three measures for at least 80% of eligible patients. There are two reporting periods available. Note that claims-based submissions must follow the 12-month reporting period only (January 1 through December 31, 2013), and the 6-month reporting period is available only via registry reporting (July 1 through December 31, 2013). The following document seeks to answer specific questions regarding the information above and provide an outline for starting to report on PQRS measures.
Click here for the complete Physician Quality Reporting System - Questions and Answers from the PAIC (last update 12-19-2012)