Gates Hospitalists, a seven-physician hospital medicine group based in Liberty, Mo., struggled for several years to qualify for incentive payments for reporting quality data to CMS for its Physician Quality Reporting System. The practice attempted to submit data on its physicians beginning in 2007, the first PQRS reporting period, but failed to receive incentive payments until it transitioned to using a registry to submit the information. Stacey Gates, JD, business manager and general counsel for the practice, said making the switch from claim-based submission to the use of a registry contributed to the group's success and recommends other practices consider a similar approach.
The impact of PQRS reporting on providers will intensify in the next few years. In 2015, CMS' carrot will turn into a stick, and eligible professionals who do not report quality data will receive a 1.5 percent penalty on their Medicare claims, rising to 2 percent in 2016 and beyond. Imposition of the 2015 penalty will be based on claims reporting from 2013.
Steven Liu, MD, founder of Ingenious Med, the provider of the registry Gates now uses to submit quality data to PQRS explains that claims-based reporting is troublesome because it relies on the generation of a "reporting bill" that has to be submitted to CMS more or less in real-time throughout the year.
Data reported to CMS must first make its way through several electronic and manual systems before it reaches the agency, explains Dr. Liu. For example, the claims may be sent through several "gatekeepers," including billing companies and Medicare Administrative Contractors, before reaching CMS, and during this journey, important data for PQRS reporting may be stripped from the claims. "Due to the complexities of the revenue cycle process, not only can data get lost on the way to CMS, but it's extremely difficult to confirm if these reporting bills even reached CMS," he says.
In contrast to claims-based reporting, registry reporting is done retrospectively, after the reporting period is over. "It's a much easier and reliable way to ensure a physician's performance on PQRS measures are accurately provided directly to CMS. Registries get an instant confirmation of receipt, so there is no doubt that the PQRS data has reached CMS," says Dr. Liu.
While Gates' leaders are frustrated they missed out on the first two years of incentive payments, they have received payments for the past two years, which has benefited the practice. Ms. Gates encourages other practices to consider registry reporting as a critical part of their strategy for successful PQRS participation.
CMS Seeks Information on Aligning Physicians' Quality Measures
PQRS overview
PQRS promotes the reporting of quality information by physicians and other eligible professionals. Providers or groups of providers who successfully submit quality measures can earn an incentive payment equal to 0.5 percent of their total Medicare Part B allowed charges for covered professional services furnished during the reporting period. Sample quality measures include the percentage of patients with diabetes who had blood pressure within normal levels and the percentage of patients with coronary artery disease who had been prescribed aspirin.The impact of PQRS reporting on providers will intensify in the next few years. In 2015, CMS' carrot will turn into a stick, and eligible professionals who do not report quality data will receive a 1.5 percent penalty on their Medicare claims, rising to 2 percent in 2016 and beyond. Imposition of the 2015 penalty will be based on claims reporting from 2013.
Claims-based vs. registry reporting
For the first two years providers were eligible for incentives, Gates Hospitalists submitted claims-based data, but came up short on satisfactorily submitting data based on CMS' standards. "We reported everything we were supposed to, but a lot of our claims-based reporting data failed to reach CMS due to issues related to the immature status of the program," said Ms. Gates.Steven Liu, MD, founder of Ingenious Med, the provider of the registry Gates now uses to submit quality data to PQRS explains that claims-based reporting is troublesome because it relies on the generation of a "reporting bill" that has to be submitted to CMS more or less in real-time throughout the year.
Data reported to CMS must first make its way through several electronic and manual systems before it reaches the agency, explains Dr. Liu. For example, the claims may be sent through several "gatekeepers," including billing companies and Medicare Administrative Contractors, before reaching CMS, and during this journey, important data for PQRS reporting may be stripped from the claims. "Due to the complexities of the revenue cycle process, not only can data get lost on the way to CMS, but it's extremely difficult to confirm if these reporting bills even reached CMS," he says.
In contrast to claims-based reporting, registry reporting is done retrospectively, after the reporting period is over. "It's a much easier and reliable way to ensure a physician's performance on PQRS measures are accurately provided directly to CMS. Registries get an instant confirmation of receipt, so there is no doubt that the PQRS data has reached CMS," says Dr. Liu.
From failure to incentive payments
To investigate what went wrong, Ms. Gates and other leaders at the practice contacted the group's billing company, which informed Gates' leaders that the only groups who were receiving PQRS incentives were those submitting through a registry. As a result of this information, Gates decided to switch to registry reporting to increase the likelihood of receiving PQRS funds.While Gates' leaders are frustrated they missed out on the first two years of incentive payments, they have received payments for the past two years, which has benefited the practice. Ms. Gates encourages other practices to consider registry reporting as a critical part of their strategy for successful PQRS participation.
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