Measure Groups

Report
TOPIC:
All Gain, No Pain PQRS Reporting
Dec. 19th, 2012: 1:00 p.m. – 2:00 p.m.
Moderator: Stephanie Gramling,
Communications Leader at Physician Sales & Service
Presented by Jim Clifford,
Senior Solutions Consultant at Wellcentive
Topics of Discussion
• PQRS and CMS
• Eligible Professionals
• Reporting Options
• Wellcentive PQRS
PQRS Overview
Providers
Incentive
Payment
Enter Patient
Data
Quality
Care
CMS
Wellcentive
Submit
Registry Data
In Your Office
Choose Reporting Method
Measure Groups
Individual Measures
Choose Measures To Report
Pick measures that fit your specialty or what services you perform.
Gather Patient Data
Run EHR Reports
Billing Data From PM System
Pull Paper Charts
Choose How You Would Like to Enter Data
Manual Entry
Upload Data Sheets
Enter Data into Wellcentive PQRS
Our intuitive application gives you feedback on the data you enter
We Submit For You
After all your data is entered, sit back and let Wellcentive do the work of submitting to CMS
Eligible Professionals (EP)
Physicians
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MD/DO
Podiatrist
Optometrist
Oral Surgeon
Dentist
Chiropractor
Ophthalmologist
Therapists
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Physical Therapist
Occupational Therapist
Qualified
Speech/Language
Pathologist
Practitioners
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Physician Assistant
Nurse Practitioner
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Clinical Nurse Specialist
Certified Registered Nurse
Anesthetist
Certified Nurse Midwife
Certified Social Worker
Clinical Psychologist
Registered Dietician
Nutrition Professional
Audiologist
The Reporting Options
Measure Groups
Individual Measures
Measure Group Reporting
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22 Diagnosis - Based Group Measures
Must report for at least 1 measure group
Must have a Performance Rate > 0%
The Reporting Period is January 1, 2012 – December 31, 2012
3 options for reporting:
Report 30 unique
Medicare Part B
FFS patients for at
least one measure
group
Report 80% or
more applicable
Medicare Part B
FFS patients for 12
months for at least
one measure
groups with a
minimum of 15
patients
Report 80% or
more applicable
Medicare Part B
FFS patients for 6
months for at least
one measure
group with a
minimum of 8
patients
Measure Groups
Measure Groups (22 measure groups)
– Diabetes Mellitus (6 measures)
– Chronic Kidney Disease (CKD) (4
measures)
– Preventive Care (9 measures)
– Coronary Artery Bypass Graft
(CABG) (10 measures)
– Rheumatoid Arthritis (6 measures)
– Perioperative Care (4 Measures)
– Back Pain (4 measures)
– Hepatitis C (8 measures)
– Heart Failure (5 measures)
– Coronary Artery Disease (CAD) (4
measures)
– Ischemic Vascular Disease (IVD) (5
measures)
– HIV/AIDS (8 measures)
– Community-Acquired Pneumonia
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(CAP) (4 measures)
Asthma (4 measures)
Chronic Obstructive Pulmonary
Disease (COPD)(5 measures)
Inflammatory Bowel Disease (IBD)
(8 measures)
Sleep Apnea (4 measures)
Dementia (9 measures)
Parkinson’s (6 measures)
Hypertension (8 measures)
Cardiovascular Disease (6
measures)
Cataracts (4 measures)
Individual Measures
• 208 Individual Measures
• Must report on a minimum of 3 measures
• Must have a Performance Rate > 0
• Eligible Professionals must report at least 80% of
their Medicare Part B FFS patients during the
reporting period for whom the measure applies to
• The Reporting Period is January 1, 2012 –
December 31, 2012
Note: For 2012 the 6-month
reporting option for Individual
Measures has been removed
The Bonus Payment
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This is a Pay-for-Reporting program
Professionals that report in years 2012-2014 successfully are
eligible for a 0.5% percent bonus payment for PQRS.
Potential bonus payment is calculated using total allowed
charges for services furnished during the reporting period
and paid under the Medicare Physician Fee Schedule.
The penalty for not reporting in 2013 is a 1.5% payment
reduction in 2015
0.5%
Incentive
for reporting
|
2012
0.5%
Incentive
for reporting
|
2013
0.5%
Incentive
for reporting
|
2014
1.5%
Penalty
for not reporting
in 2013/2014/2015
|
2015
Why Registry?
Registry-Based
Claims-Based
2010 Success Rate: 91%*
2010 Success Rate: 57%*
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Submit 2012 data right up until the CMS
deadline in March 2013 (no need to track
claims throughout the year)
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Must have someone in the clinic who “owns”
PQRS: complete audits, know all the ins/outs,
keep record of the % completed, etc.
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Higher potential for meeting reporting
criteria and receiving bonus payment
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Auditing process can be tedious and
potentially a productivity loss, especially if you
have a large Medicare patient population
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Measures and measure groups updated
automatically each year as information is
provided by CMS, which keeps staff from
having to become measure experts
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Must complete and submit proper forms in
proper format for eligible patients
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No internal automated check/ balance
system provided by billing company: submits
only what you give them
*Centers for Medicare and Medicaid Services, 2010 PQRS Reporting Experience, February 2012
Why Wellcentive?
The most streamlined, reliable reporting solution available
• Easy registry-based reporting - just provide data on 30 unique
Medicare Part B FFS patients for a single measure group
• Data verification prior to submission delivers 99% incentive eligibility
• Maintain staff productivity with fast, simple reporting
• Enterprise PQRS solutions available for larger organizations
A leader in PQRS reporting
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Comprehensively certified by CMS since 2007
Worked with CMS to test registry submission process in 2007
Charter Founder Member of the CMS Registry Initiative
Summary
• Identify the patients for whom PQRS measures apply
• Capture clinical information
• Enter your data electronically to Wellcentive or
enter manually into Wellcentive PQRS data
collection tool
• We Submit the data to CMS for you
• Integrate the measures into your practice
• Improve Quality!
Thank You!
For FAQs and to register please visit:
www.PSS-PQRS.com
The goal is improving patient wellness.

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