PQRS – You Can Do It!

Lea Chatham December 9th, 2013

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Ok, maybe you’re too busy to manage the full reporting required to get the .5% incentive for 2013, but you can avoid the much larger (1.5%) penalty—and it’s easy! You don’t have to submit the full reporting to avoid the penalty. You only need to submit a single claim. Anyone can do it!

That single claim just needs to report one measure, and you’re done. You avoid the -1.5% penalty, which will apply in 2015 for all of your Part B Medicare claims. The deadline to participate in PQRS to avoid a penalty starting in 2015 is December 31, 2013.

Once you have avoided the penalty for 2013 reporting, you can get focused on 2014. Why? Because all these individual Medicare penalties seem small when you look at them separately but they add up fast. Elizabeth Woodcock provided a great overview of the total penalties in our last PQRS blog post.

All of the information you need on who is eligible, how to participate, what the measures are, etc. is available on the CMS website.  And, the CMS has a provider information call about the new PQRS rule for 2014—with open Q&A—coming up on December 17. If your EMR is certified for direct reporting to the PQRS system, you may even be able to satisfy a Meaningful Use (MU) Stage 1 requirement as well.

Let’s take a quick look at the overview of incentives and penalties for PQRS (and the VBPM program, which also applies a penalty based on PQRS reporting) courtesy of Laurie Morgan, Senior Consultant and Partner at Capko & Morgan, a practice management consulting company.

Kareo PQRS Information

As you can see, the penalties just keep increasing, and when you combine these with other penalties for eRx and MU, it can add up to -11% by 2020. That is not a pittance by any means.

In a recent webinar, Prepare to Profit from the Changing Payment Landscape, hosted by Medical Economics and sponsored by Kareo, Laurie Morgan also answered a few questions about PQRS for the audience that may help you as well:

  1. If I am a new practice starting in 2014, will I penalized for not reporting in 2013 or does the whole thing start for me in 2014?
    If your practice didn’t exist in 2013—meaning you weren’t yet practicing and didn’t see any Medicare patients in 2013—then you would not have been required to report. But, if you are practicing now and seeing Medicare patients, and simply plan to leave your current practice to form your own, then you would have been expected to report.
  2. We are a practice that sees virtually no Medicare or Medicaid patients, should we really bother with PQRS?
    The penalty applies to your Medicare payments in 2015, so if you believe your Medicare volume will increase by then, it is probably worthwhile to report—even if your volume is trivial now.
  3. Can we use G code G8553 to report on our single claim?
    Our assumption is that G8553 is solely for eRx and not PQRS, but this is a great question for the CMS Medicare Learning Network call on December 17.

If you are finding all of these new programs and changes in healthcare reimbursement overwhelming, being able to do one simple step to avoid a penalty is a refreshing option. Don’t miss your chance to avoid the 2015 PQRS penalty. Submit your single PQRS reporting claim now.

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