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Monday, June 12, 2017

CMS looking for feedback on website

The Centers for Medicare & Medicaid Services (CMS) is expanding its new Quality Payment Program website to give administrative staff tools to better manage practice and physician information. As part of the process, CMS is looking for people to help provide feedback.

Specifically, CMS is looking for:
•    Clinicians or health care providers who look at Medicare feedback reports
•    Administrative staff and office managers who are familiar with Medicare systems or Medicare quality data submission

Participants must:
•    Belong to a practice of 15 or fewer physicians or other health care professionals
•    Work for a practice that plans to participate in the Quality Payment Program for 2017
•    Be familiar with Medicare feedback reports (previously known as Quality and Resource Use Reports) or plan to review Quality Payment Program feedback

The feedback sessions, which will take place online or by telephone, will last about an hour. Participants will receive $150-$200 for their time.

If you are interested in participating, please email Partnership@cms.hhs.gov with the subject line “Participation for QPP Feedback Report Research”, and someone from CommunicateHealth (a CMS-authorized contractor) will follow up with you directly.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, April 6, 2017

Time ticking for MIPS registration

If your physician group intends to use the Centers for Medicare & Medicaid Services (CMS) Web Interface to report to the Merit-Based Incentive Payment System (MIPS) or the Consumer Assessment of Health Providers and Systems (CAHPS) you have until June 30 to register. You can use the Quality Payment Program (QPP) website to register. No registration is required if you are reporting as an individual or if your group is using any other reporting method.

Only groups of 25 or more clinicians can report using the CMS Web Interface. However, groups of two or more clinicians may administer CAHPS, which is optional in MIPS. Group participants in a Shared Savings Program accountable care organization do not need to register.

CMS has automatically registered groups for the CMS Web Interface if they previously registered as a group under the Physician Quality Reporting System (PQRS). If you need to review or remove your registration, you can do so through the QPP website.

To register, a member of the group must have a valid Enterprise Identity Management (EIDM) account with the Physician Value-Physician Quality Reporting System (PV-PQRS) role. If you are unsure if someone in your group has this role or need to reactivate your account, you can contact the QPP desk at 866-288-8292 or qpp@cms.hhs.gov. CMS has created guides for obtaining the PV-PQRS role or creating a new EIDM account. A CMS Web Interface Registration Guide, a CMS Web Interface fact sheet, and a CAHPS for MIPS fact sheet are also available. CMS will be hosting educational webinars on group reporting and registration in the future.

The QPP was created under the Medicare Access and CHIP Reauthorization Act (MACRA) and adjusts Medicare payments based on the quality of care provided by physicians instead of the volume of services. The first performance period for the QPP began on Jan. 1. More information is available on the American Academy of Family Physicians MACRA ready page.

– Erin Solis, Regulatory Compliance Strategist at the American Academy of Family Physicians

Friday, February 3, 2017

Deadline extended for certain PQRS reporting

If you are reporting to the Physician Quality Reporting System (PQRS) using the Electronic Health Record (EHR) method, you now have a little more time to submit your data. The Centers for Medicare & Medicaid Services (CMS) recently announced that it was extending the Feb. 28 deadline for PQRS submission through the EHR or qualified clinical data registry (QCDR) mechanisms.

Eligible professionals (EPs) and groups have until March 31 to submit their 2016 quality reporting document architecture (QRDA) I or III files for the EHR Direct, EHR Data Submission Vendor (DSV), and QCDR reporting mechanisms. Qualified registries and QCDRs that use XML files also have until March 31 to submit. Vendors may have their own individual deadlines that may be earlier. EPs should work directly with their vendors to ensure their data is submitted before the deadline.

EPs who fail to satisfactorily report to PQRS for 2016 will receive the maximum negative payment adjustment in 2018. EPs failing to report will also face the maximum negative payment adjustment for their group size under the Value-Based Payment Modifier Program (VBPM). Payment adjustments for the PQRS and VBPM are separate from those for the Medicare Electronic Health Record Incentive Program (a.k.a “meaningful use”). EPs have until March 13 to submit their meaningful use data. EPs can submit CQMs using the PQRS EHR reporting method or QCDR QRDA III files to fulfill the CQM requirements for both meaningful use and PQRS. EPs can contact the QualityNet Help Desk for questions about PQRS and the EHR Information Center Help Desk (1-888-734-6433, option 1) for questions relating to meaningful use.

The final year for which EPs are required to submit data for PQRS, VBPM, and meaningful use is 2016. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 consolidates these programs into the Quality Payment Program (QPP). The first performance period for the QPP began on Jan. 1. Physicians can learn more about the QPP on the AAFP website or in the latest issue of FPM.

– Erin Solis, Regulatory Compliance Strategist at the American Academy of Family Physicians

Tuesday, January 10, 2017

Physicians, groups to get breather on PQRS penalties

It seems the most recent round of updates to ICD-10 coding has caused enough concerns at the Centers for Medicare & Medicaid Services (CMS) that the agency is temporarily eliminating payment penalties based on those changes.

The CMS this week announced that the changes are expected to affect its ability to process data for certain quality measures within the Physician Quality Reporting System (PQRS). As a result, individuals and groups that fail to satisfactorily report 2016 PQRS data solely because of the 2016 coding changes will not face 2017 or 2018 PQRS negative payment adjustments. Those who fail to satisfactorily report for reasons other than coding, however, are still at risk.

The changes affected a variety of measures, but the majority related to diabetes, pregnancy, cardiovascular, oncology, mental health, and eye disease diagnosis. This includes the diabetes, cataracts, oncology, cardiovascular prevention, and diabetic retinopathy measures groups.

Even if you believe the changes to ICD-10 affected your ability to meet the reporting requirements satisfactorily, CMS still expects you to report to PQRS. Once the 2016 reporting period ends, CMS plans to conduct an analysis to review and determine which submissions were negatively affected by the ICD-10 changes. Individuals and groups that feel they have received a negative payment adjustment as a result of the ICD-10 changes will also be able to file an informal review.

CMS advises that eligible professionals (EPs) should use the codes in the measure specification sheets for their respective reporting mechanism. Qualified registry, electronic health record, and qualified clinical data registry vendors should continue to calculate the measures according to their particular measure specification sheet.

EPs and vendors can contact the QualityNet Help Desk for assistance. CMS has also published frequently asked questions.

--Erin Solis, Regulatory Compliance Strategist at the American Academy of Family Physicians

Friday, December 2, 2016

CMS extends deadline to review value modifier and PQRS results

The Centers for Medicare & Medicaid Services (CMS) has extended until Dec. 7 the deadline for family physicians and others to request an informal review of their value modifier and Physician Quality Reporting System (PQRS) results, which will otherwise impact Medicare physician payments in 2017.

CMS released the 2015 annual Quality and Resource Use Reports (QRURs) on Sept. 26. The 2015 annual QRURs show how physician groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier as well as their 2017 Value Modifier payment adjustment.

You can access and review your 2015 annual QRUR now to determine whether you are subject to the 2017 Value Modifier payment adjustment. You will need an Enterprise Identity Management (EIDM) account with the appropriate role to obtain your 2015 annual QRUR. The CMS web site contains instructions for signing up for the appropriate role in EIDM and instructions for accessing the QRUR. Also available on this webpage is a streamlined instructional guide for accessing the QRUR titled “Quick Access Guide for the 2015 Annual QRURs and Tables.”

Physician groups or solo practitioners may request an informal review of perceived errors in their 2017 Value Modifier calculation during the informal review period, which now expires on Dec. 7 at 11:59 p.m. (EST). Additional information about the 2015 Annual QRURs and how to request an informal review is available on CMS’s 2015 QRUR and 2017 Value Modifier webpage.

In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report under the Physician Quality Reporting System (PQRS) in 2015.

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, you can also submit an informal review request for that and ask CMS to investigate your payment adjustment determination. However, again, you must do so by Dec. 7. CMS will be in contact with every individual eligible professional or PQRS group practice that submits a request for an informal review of their 2015 PQRS data and notify them via email of a final decision within 90 days of the original request for an informal review. All CMS decisions will be final, and there will be no further review.

Follow these steps to submit an informal review request:
1.    Go to the Quality Reporting Communication Support Page (CSP).
2.    In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page.”
3.    Select “Informal Review Request.”
4.    Select “PQRS Informal Review.”
5.    A new page will open.
6.    Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit.”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact you for additional information if necessary. Please see the PQRS informal review fact sheet for more information.

Additionally, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an EIDM account. For details on how to obtain your report, please see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports.” For information on understanding your report, please see the “2015 PQRS Feedback Report User Guide.” Both guides are on the PQRS Analysis and Payment webpage on the CMS web site.

For More Help:
•    For additional assistance regarding EIDM or to ask questions about the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715- 6222) from 7:00 a.m. to 7:00 p.m. Central Time, Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.
•    For additional assistance regarding the QRUR or the Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, September 30, 2016

See if you’re due a penalty in the 2015 PQRS physician feedback report

Individual physicians and groups can now access their 2015 Physician Quality Reporting System (PQRS) Physician Feedback reports, which provide valuable information about your practice and whether you will face a Medicare penalty in 2017.

Physicians can access the reports through the CMS Enterprise Portal. Users must have an Enterprise Identity Management (EIDM) account with the appropriate role to access the reports. You can also access your Quality and Resource Use Reports (QRUR), which were also recently released, through the same portal.

The Physician Feedback reports will provide the determination on whether you met the PQRS criteria to avoid a 2 percent negative payment adjustment in 2017. Information is available for all measures reported by your National Provider Identifier (NPI) for each reporting method. You can review if your successfully reported all your measures and see a brief rationale for any payment adjustment, such as insufficient measures reported. It also includes reporting rate and performance rate percentages.

You can file an informal review request if you feel the negative payment adjustment was an error. The informal review period is open until Nov. 30. Reviews can be filed through the Quality Reporting Communication Support Page. For more information or additional questions, contact the QualityNet Help Desk at qnetsupport@hcqis.org or (866) 288-8912. A Feedback Report User Guide is available online.

The Centers for Medicare & Medicaid Services will mail out payment adjustment notification letters at a later date. Accessing the Physician Feedback reports now will allow you to review your performance and file an informal review before the deadline.

– Erin Solis, Regulatory Compliance Strategist at the American Academy of Family Physicians

Wednesday, September 28, 2016

QRUR reports for 2015 now available

The 2015 annual Quality and Resource Use Reports (QRUR) are now available to all group practices and solo practitioners. The report released by the Centers for Medicare & Medicaid Services (CMS) provides data on a practice’s performance on quality and cost metrics. The QRUR also provides information on how the practice fared under the 2017 Value-Based Payment Modifier (VBPM).

Authorized representatives can access the QRUR through the CMS Enterprise Portal with their Enterprise Identity Data Management (EIDM) credentials. You must have the correct role within the EIDM to access the report. CMS has provided guides on obtaining an EIDM account and how to obtain a QRUR.

Physicians will find in the reports performance information on the measures they submitted to the Physician Quality Reporting System (PQRS). CMS also calculates several claims-based quality and cost measures. Along with the QRUR, you can download an Excel file containing provider- and patient-level data. The information provided in the spreadsheets allows physicians to identify areas for improvement in cost and quality performance.

In 2017, all solo- and group-eligible professionals will be subject to the VBPM. Payment adjustments for the VBPM depend on practice size. It is important to review the information in the QRUR for accuracy. If you feel you have been assessed a payment penalty incorrectly, you can file an informal review through Nov. 30. You can submit a review through the CMS Enterprise Portal, or you can contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3). The help desk is available by phone Monday-Friday 8 a.m.-8 p.m. EST.

Becoming familiar with the QRUR now is important as it will continue in some form under the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA's Merit-Based Incentive Payment System (MIPS) incorporates elements of PQRS and the VBPM. The initial performance period is slated to begin in 2017.

– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians

Thursday, July 28, 2016

You'll need an EIDM account for this year's feedback reports

The Centers for Medicare & Medicaid Services (CMS) is encouraging physicians to sign up or reactivate their Enterprise Identity Management (EIDM) accounts now ahead of the release this fall of a pair of important feedback reports. EIDM accounts are required to access the information, and signing up now will prevent delays when the reports are released.

An EIDM account allows physicians to view and download their Physician Quality Reporting System (PQRS) feedback report and Quality and Resource Use Report (QRUR). The PQRS report provides information on your performance in 2015 and any payment adjustments for 2017. The 2015 QRUR includes information on how your practice fared on quality and cost measures as well as any payment adjustment you may receive under the Value-Based Payment Modifier. (For more information, see "What You Need to Know About Medicare's New 'Quality and Resource Use Report'," FPM, November/December 2015.)

To sign up for an account, visit the CMS Enterprise Portal website and click “New User Registration” located under the CMS Secure Portal heading. Once you’ve created your username and password, you will need to request access for the “Physician Quality and Value Programs.” From there you can select the type of role. Each organization must have at least one Security Official unless they are a solo practice, in which you would designate an Individual Practitioner. If you need assistance in signing up for an account or are unsure if you or someone in your practice already has an account, you can contact the QualityNet Help Desk at 866-288-8912.

CMS has created an EIDM System Toolkit containing guides on signing up for an account. It is a good idea to review this information before beginning the application process to make sure you have all the information you need. CMS make take several weeks to approve your role request, so it is important to begin this process as early as possible.

– Erin Solis is the Regulatory Compliance Strategist at the American Academy of Family Physicians

Tuesday, May 31, 2016

CMS releases list of approved 2016 PQRS registry vendors

The Centers for Medicare & Medicaid Services (CMS) has released the 2016 lists of approved Qualified Registries and Qualified Clinical Data Registries for the Physician Quality Reporting System (PQRS). Physicians and group practices may use these third-party vendors to submit quality measures for PQRS in 2016 and potentially avoid payment penalties associated with PQRS and the Medicare value-based payment modifier in 2018.

There are a number of other PQRS reporting options. For those new to the program, the AAFP provides a PQRS overview, and CMS has instructions on how to get started.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Wednesday, April 6, 2016

Groups can now register for the 2018 PQRS

Physician practices wanting to use the Group Practice Reporting Option (GPRO) to participate in the 2018 Physician Quality Reporting System (PQRS) have until June 30 to register. If not, all providers within the group must report to PQRS as individuals or face a Medicare pay penalty in 2018.

The Centers for Medicare & Medicaid Services (CMS) defines a “group” as a single Tax Identification Number (TIN) with two or more individual providers with National Provider Identifiers (NPIs) who have reassigned billing rights to the TIN. Groups can register using an Enterprise Identity Management (EIDM) account. CMS encourages users to create or modify existing EIDM accounts now to avoid delays. If you are unsure if someone in your group is already enrolled with the EIDM system, contact the QualityNet Help Desk. You will need the group’s TIN and name.

During registration, you will select your reporting method. Your choices are:
•    Qualified PQRS Registry
•    Electronic Health Record (EHR)
•    Qualified Clinical Data Registry (QCDR)
•    Web Interface (for groups with more than 25 providers)

Physicians wanting to report using the EHR or QCDR methods will need to be sure that their vendors meet the requirements for group reporting. Additionally, groups with between two and 99 eligible professionals (EPs) will need to decide if they want to supplement their reporting with the Consumer Assessment of Health Care Providers and Systems (CAHPS) for the PQRS survey. CAHPS is required for groups with 100 or more EPs.

All groups and solo physicians will be subject to the 2018 Value Modifier. Participation in the PQRS program will help you avoid the automatic downward payment adjustment for failure to satisfactorily report.

--Erin Solis is the regulatory compliance strategist for the American Academy of Family Physicians

Friday, February 5, 2016

Diabetes foot exams among changes in 2016 PQRS

The 2016 version of the Physician Quality Reporting System (PQRS) included a number of changes, but the revised diabetes foot exam is especially important to note because it requires more work than the measure it replaced.

The previous measure, “Diabetes: Foot Exam,” asked for a visual inspection of the foot along with a sensory exam using a monofilament and a pulse exam. The new measure, “Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation,” specifies that the sensory exam include a monofilament plus one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexed, or vibration perception threshold. This exam only needs to happen once a year, but it is important to document correctly.

In addition, the new measure, with some exceptions, applies to all patients with diabetes over the age of 18. The previous measure covered patients ages 18-75.

Remember, physicians who do not meet PQRS requirements in 2016 face a 2-percent cut in Medicare payments in 2018.

– Amy Mullins, MD, Medical Director of Quality Improvement, American Academy of Family Physicians

Wednesday, January 27, 2016

CMS sets submission deadlines for 2015 PQRS data

Have you submitted your 2015 Physician Quality Reporting System (PQRS) data yet? If not, you still have time to do so without incurring a penalty in 2017.

The Centers for Medicare & Medicaid Services (CMS) has announced the 2015 PQRS data submission deadlines, which vary depending on how you plan to submit your data:

•    Electronic Health Record Direct or Data Submission Vendor (quality reporting data architecture I/III) – Feb. 29
•    Qualified Clinical Data Registries (quality reporting data architecture III) – Feb. 29
•    Group Practice Reporting Option Web Interface – March 11
•    Qualified Registries (such as the PQRS Wizard) – March 31
•    Qualified Clinical Data Registries XML – March 31

All submission deadlines end at 8 p.m. (EST) on the date listed. You will need an Enterprise Identity Management (EIDM) account with the “Submitter Role” for these PQRS data submission methods. Please see the EIDM System Toolkit for additional information.

Also, be aware that the Physician and Other Health Care Professionals Quality Reporting Portal may be unavailable while the system is undergoing maintenance. Maintenance is currently scheduled for the following time frames (all times are EST):

•    Feb. 26 at 8 p.m. – Feb. 29 at 6 a.m.  
•    March 11 at 8 p.m. – March 14 at 6 a.m.  
•    March 16 at 8 p.m. – March 21 at 6 a.m.  

Eligible professionals who do not satisfactorily meet the 2015 PQRS requirements will be subject to a reduction in payment on all Medicare Part B Physician Fee Schedule services rendered in 2017.

For questions, please contact the QualityNet Help Desk at 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 8 a.m. – 8 p.m. (CST). Complete information about PQRS is available on the CMS web site.  

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, November 24, 2015

CMS extends QRUR informal review period again

The Centers for Medicare & Medicaid Services (CMS) announced last week that it has again extended the deadline for practices to request an informal review of their Quality and Resource Use Reports (QRURs). The QRURs contain data used for both the Physician Quality and Reporting System (PQRS) payment adjustment and the Value-Based Payment Modifier (VBPM) calculation. Practices now have until 11:59 p.m. EST on Dec. 16 to request an informal review. Results of an informal review will be emailed within 90 days of the original request. All results of the informal review are final.

This announcement comes on the heels of the updated release of the 2014 QRURs, which corrected previous issues with validating the accuracy of data submitted using the Electronic Health Record (EHR) or Quality Clinical Data Registry (QCDR) reporting methods.

For additional information on interpreting your QRUR, see the November/December issue of Family Practice Management.

-Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians

Friday, November 20, 2015

CMS updates 2014 QRURs to correct data

Two months after their release, the 2014 Quality and Resource Use Reports (QRURs) – which will help determine if physicians and practices get Medicare bonuses or penalties in coming years – have been updated.

The Centers for Medicare & Medicaid Services (CMS) said it identified problems with data submitted by providers through electronic health records and the Qualified Clinical Data Registry. The agency also found technical issues with claims used to determine claims-based measures.

CMS says it has fixed these problems and has released revised 2014 QRURs, which are now available through the CMS Enterprise Portal. The agency said the corrections did affect the Value-Based Payment Modifier for a small number of providers who will be notified. The modifier affects Medicare reimbursement in future years based on whether providers meet quality and cost of care requirements.

Friday, November 6, 2015

CMS extends deadline for QRUR informal reviews

Physicians who have not yet requested an informal review of their Quality and Resource Use Reports (QRURs) are getting more time.

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline to request a review of the QRUR, which is a key piece of both the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBPM). Eligible professionals (EPs) now have until 11:59 Eastern Time on Nov. 23 to request an informal review. Under the VBPM, groups of 10 or more EPs can request a review if they feel their 2016 value modifier was incorrectly calculated. Under PQRS, EPs can request a review if they feel they have been assigned a penalty erroneously.

The 2014 QRURs were released in September and contain performance information related to the quality and cost measures used to calculate the 2016 VBPM. The reports also indicate if a provider satisfactorily reported under PQRS for 2014. A provider who did not satisfactorily report should have received a letter from CMS last month indicating that they will receive a 2 percent cut in all of their 2016 Medicare physician fee schedule payments.

CMS allows a 60-day review period of QRURs; however, CMS announced on Oct. 30 that it was granting a two-week extension. Providers can contact the Physician Value Help Desk (1-888-734-6433 option 3 or pvhelpdesk@cms.hhs.gov) for additional information on how to request an informal review. It is important for providers to note that the result of the informal review is final and cannot be appealed. CMS submits its final decision by email within 90 days of the request.

In addition, look for an article on QRURs in the November/December issue of Family Practice Management.

– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians

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