2014 Rules for PQRS

CMS issued Final 2014 Physician Fee Schedule Rule on November 27, 2013.

Summary of Changes:

  • 2014 PQRS measures group reporting can only be done with a registry.
  • 2014 PQRS Measures Groups Specifications Manual  –  It include codes and reporting instructions for the 25 PQRS measures groups for registry-based reporting.
  • It is easier for a provider to report 2014 PQRS with a registry instead of using claims because a provider only needs to report 20 patients with a measures group and most measure groups have less than 9 measures.
  • 2014 PQRS Measures Groups Release Notes – Summary of 2014 updates made to the 2013 PQRS Measures Groups Specifications.
  • 2014 PQRS Measures Groups Single Source Code Master – Includes a numerical listing of all codes included in 2014 PQRS Measures Groups.  It can be used to select the eligible patient for each PQRS measures group.
  • 2014 PQRS bonus is 0.5% of the total estimated Medicare Part B allowed charges.
  • The penalty for not reporting 2014 PQRS is 2%.
  • 2014 individual PQRS measures reporting: report at least 9 measures, OR, if less than 9 measures apply to the eligible professional, report 1—8 measures, AND report each measure for at least 50 percent of the eligible professional’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. The 9 measures need to cover at least 3 NQF domains: Patient Safety; Person and Caregiver-Centered Experience and Outcomes; Communication and Care Coordination; Effective Clinical Care; Community/Population Health; Efficiency and Cost Reduction
  • When reporting individual PQRS measures with a registry, usually a provider will need to report 9 measures across 3 different domains for at least 50% of applicable patients. However, there is an exception to this rule if a provider reports ALL the individual PQRS measures INSIDE a Cluster of Clinically Related Measures. For example, if reporting only the Melanoma PQRS cluster (137, 138, 224), a dermatologist would earn the 2014 PQRS incentive payment and avoid the 2016 PQRS Payment Adjustment as long as the provider reports all three measures successfully for at least 50% of applicable patients. The list of all Clusters of Clinically Related Measures can be found at 2014 PQRS Measure Applicability Validation (MAV) Process for Registry-Based Reporting of Individual Measures
  • 2014 PQRS Measures List – Identifies and describes the measures used in PQRS, including all available reporting methods/options, corresponding PQRS number and NQF number, NQS domains, plus measure developers and their contact information. For more info on each individual measure, please click here.
  • 2014 PQRS Measure Specifications Manual for Reporting of Individual Measures – Includes codes and reporting instructions for the 2014 PQRS measures for claims and/or registry-based reporting.
  • 2014 PQRS Individual Measures Specification Release Notes – Summary of 2014 changes made to the 2013 PQRS Individual Measures Specifications.
  • 2014 PQRS Individual Measures Single Source Code Master – This excel file includes a numerical listing of all codes (denominator and numerator) included in 2014 PQRS Individual Claims and Registry Measures. It can be used to select the eligible patient for each individual PQRS measure.
  • PQRS GPRO measures collected through the GPRO web interface during 2012 will be publicly reported on Physician Compare in 2014
  • 2014 GPRO PQRS: report at least 9 measures covering at least 3 of the NQS domains, OR, if less than 9 measures covering at least 3 NQS domains apply to the group practice, report 1—8 measures covering 1-3 NQS domains for which there is Medicare patient data, AND report each measure for at least 50 percent of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. For a group practice who reports fewer than 9 measures covering less than 3 NQS domains via the registry-based reporting mechanism, the group practice would be subject to the MAV process, which would allow CMS to determine whether a group practice should have reported on additional measures and/or measures covering additional NQS domains.
  • CMS will publicly report some 2014 PQRS individual measure data in 2015 if technically feasible.
  • 2014 PQRS GPRO self-nomination deadline is September 30, 2014
  • Group practices of 25-99 eligible professionals that would like to report the CG CAHPS survey measures need to use a CMS-certified survey vendor.
  • 2014 value-based payment modifier policies:
  • The value-based payment modifier applies to groups of physicians with 10 or more eligible professionals in 2016.
  • The amount of payment at risk under the value-based payment modifier increases from 1.0 percent to 2.0 percent in 2016.
  • Groups of physicians with between 10 and 99 eligible professionals are subject only to upward or neutral adjustment determined under the quality-tiering methodology.
  • Groups of physicians with 100 or more eligible professionals are subject to upward, neutral, or downward adjustments determined under the quality-tiering methodology.
  • CY 2014 Medicare Physician Fee Schedule (PFS) Final Rule - Slide Presentation. This presentation covers program updates to the Physician Quality Reporting System (PQRS). In particular, it includes details on how an eligible professional (EP) or group practice can meet the criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment. In lieu of satisfactory reporting, it also covers how to meet the criteria for satisfactory participation under the new qualified clinical data registry option, which will be implemented in 2014 as a result of the American Taxpayer Relief Act of 2012. In addition to the PQRS, this presentation contains additional program updates to the Electronic Health Record (EHR) Incentive Program and Physician Compare.