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Physician Quality Reporting System

For eligible providers who fail to meet the criteria specified for satisfactory reporting or participation in the 2016 Physician Quality Reporting System (PQRS), the one thing they can look forward to is a negative payment adjustment. CMS says it will make “no exceptions” here, having mentioned this in the official 2016 PQRS: Implementation Guide.

The PQRS quality reporting program makes use of negative payment adjustments to boost the reporting of quality information by EPs and group practices. In 2018, negative adjustments will be applied on claims payments, and for those that are under the Medicare Physician Fee Schedule, this is 2 percent. The statistic will be based on 2016 reporting.

How To Perform Successful Reporting

The first order of business is to figure out whether you are an eligible provider or eligible group practice, and then check out the updated 2016 list from CMS, which lays out the Eligible Professionals. This step takes care of determining your eligibility, because if you are an EP, it is important to figure out your preferred mode of participation. After that, the next step is choosing a reporting mechanism.

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Negative Payment Adjustment

Medicare Part B claims may be used by EPs, with the alternative of reporting through a qualified PQRS registry, a direct certified EHR, or a qualified clinical data registry. Group practices who qualify can report using a qualified PQRS registry, a web interface, a direct certified EHR, a certified EHR via a data submission vendor, or Consumer Assessment to Healthcare Providers and Systems for PQRS through a survey vendor certified by CMS.

After all of these details have been dealt with, you will need to choose the quality measures that you will be reporting. This year, CMS has brought out a new web-based tool for use by EPs, which allows the latter to search for measures that they can report for the 2016 PRQS Program. At least nine of these individual measures will need to be chosen across three National Quality Strategy domains, or a single measure group. EPs with at least one Medicare patient they have met face-to-face will be required to report one crosscutting measure.

Another rule is that reporting should be done by the deadline. For the 2016 PQRS program year, this will be on the last day of the last month, for both EPs and group practices. Before making any decisions, practices are urged to download and review the 2016 Beginner Reporter Toolkit from the CMS website.

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