Industries: Healthcare – PQRS
The 2015 Covisint PQRS web application is expected to open this summer. Check back for an official date.
Do the 2015 PQRS reporting requirements have you totally overwhelmed and confused?
With Covisint PQRS you can confidently avoid the 2017 payment adjustment of -2.0%. Our PQRS experts receive calls daily with questions like,
- What if I don’t participate in PQRS?
- Should I register as a GPRO?
- Should I report a measures group or individual measures?
- How will the Value Based Modifier affect me?
Click on the FAQ tab to get answers to all of your PQRS questions.
Plan to attend a webinar – schedule to be posted soon. Call us at 866.823.3958 or email us at firstname.lastname@example.org.
Refer to the CMS links below for additional information
PQRS Made Easy.
Participation in the Physician Quality Reporting System, formerly known as PQRI, does not have to be complicated with complex coding systems and expensive manual processes. Whether a single provider or large hospital group, Covisint PQRS simplifies the PQRS process.
PQRS for large provider groups, Hospitals, GPRO or individual eligible professionals.
According to the final rule for 2015 PQRS reporting, to avoid the -2.0% penalty, each eligible professional needs to report at least 9 individual measures across 3 domains for at least 50% of their applicable Medicare Part B FFS patients as well as one cross cutting measure.
Large provider groups can use Covisint PQRS to meet these requirements by providing a combined data file that includes data from:
- Practice Management, Billing and/or Claims Systems
- Lab Data
- Prescriptions or Pharmacy Claims Data
The data is evaluated to determine which CMS measures are applicable to your patient population, analyzed to determine the distribution of measures per provider (or per group for GPRO) and electronically submitted to CMS. Covisint PQRS offers a simple, effective and affordable way for every provider to meet the 2015 PQRS reporting requirements.
One reporting option for eligible professionals (EPs) is to report a single measures group. A measures group is a group of quality measures for a particular condition. Covisint offers all 25 CMS-approved measures groups. Simply use our data collection forms to collect the clinical data for 20 unique patients (greater than half need to be Medicare Part B fee-for-service) then enter and submit the data using the Covisint PQRS application. No coding errors—just real clinical data resulting in real payments.
Measures Group data collection forms:
Individual Measure Reporting:
Don’t see a measures group that fits? To avoid the 2017 penalty, eligible professionals (EPs) can alternatively report on at least 9 individual measures across 3 domains for at least 50% of Medicare Part B FFS patients to which each respective measure applies. Less than this will subject the provider to the MAV. Additionally EPs with at least one face–to-face encounter must report at least one cross cutting measure.
By using Covisint PQRS, providers can self-report to meet these requirements. No dropped G-codes or worries that you haven’t done enough. Click below for more information.
- Claims-based – where quality data codes associated with individual measures (pieces of clinical data) are reported and turned in on claims directly to CMS
- EHR-based – where eligible professionals report quality measures using a qualified EHR
- Registry-based – where eligible professionals or groups report data for individual measures or measures groups to a CMS-certified registry like Covisint PQRS
For additional information, visit the CMS website at www.cms.gov/pqri.
In 2012 CMS added the ability to request a feedback report through the Quality Reporting Communication Support page at http://www.qualitynet.org/pqrs (see the Related Links in the upper left corner of the web page). Click on the Communication Support Page link then choose Create NPI Level Report Request and follow the instructions to request your feedback report.
PQRS 2015 Reporting Requirements
- There are two new measures groups. Five measures groups were dropped. See question below on available measures groups for 2015.
- Failure to report will result in a negative payment adjustment of -2.0% in 2017. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.
- EP’s with 2+ providers must either 1) register to report as a GPRO OR 2) at least ½ of the eligible professionals under their tax ID must report successfully. See the question on the VM for more information.
- Refer to the 2015 Measure Group specifications for each measure group to see any specific reporting and patient requirements changes.
- Individual measure reporting requires reporting on 9 measures across 3 domains at a 50% reporting rate in order to avoid the payment adjustment. In addition EP’s who have at least one face-to-face encounter are required to report a minimum of one cross-cutting measure. EPs who report 1-8 measures will be subject to the Measure-Applicability Validation (MAV) process. Refer to the CMS webpage for more information on MAV.
- Groups with 100+ providers are required to have all CAHPS for PQRS survey measures reported on its behalf via a CMS certified survey vendor, and report at least 6 additional measures, outside of CAHPS for PQRS, covering at least 2 of the NQS domains using the qualified registry.
New in 2011 and remaining for 2015 is the zero percent performance rule– see question specific to this topic below for additional information.
For measures group reporting EPs can report on one measures group for 20 applicable patients.
Refer to the CMS registry reporting made simple document for more information.
The individual measure reporting option through a qualified registry requires reporting on only Medicare Part B FFS patients including primary, secondary and railroad.
- Asthma (5-64)
- CABG (18+)
- CAD (Coronary Artery Disease) (18+)
- Chronic Obstructive Pulmonary Disorder (COPD) (18+)
- CKD (Chronic Kidney Disease) (18+)
- Dementia (All ages)
- Diabetes (18-75)
- General Surgery (18+)
- Heart Failure (18+)
- Hepatitis C (18+)
- HIV/Aids (13+)
- Irritable Bowel Disease (IBD) (18+)
- Oncology (18+)
- Optimizing Patient Exposure to Ionizing Radiation (OPEIR) (18-75)
- Parkinson’s (18+)
- Preventive Care (50+)
- RA (Rheumatoid Arthritis) (18+)
- Sleep Apnea (18+)
- Total Knee Replacement (TKR) (18-75)
New in 2015:
- Acute Otitis Externa (AOE) (2+)
- Sinusitis (18+)
An eligible professional reporting via registry for a measures group needs to report all of the measures in the group (where the patient is eligible for the measure) for 20 patients AND have a performance rate >0% for each applicable measure during a specified reporting period to be considered incentive eligible. Note: An inverse measure with a 100% performance rate will not be counted as satisfactorily reporting the measures group. In cases where a measure within a measures group is not applicable to a patient, the patient would not be counted in the performance denominator for that measure, so those patients should not be affected (e.g., Preventive Care Measures Group – Measure #39: Screening or Therapy for Osteoporosis for Women would not be applicable to male patients according to the patient sample criteria). An answer of “Not Done/Unknown” or “Performance Not Met” equivalent for all eligible patients for a given measure within the measures group will result in a performance rate of 0% for that measure and the provider will not have successfully reported.
Providers with specialties that do not fit within the guidelines for measures groups approved by CMS are encouraged to report using an alternative reporting method. Covisint also offers an individual measure reporting option. Refer to our webpage for more information on alternative reporting methods or contact us for additional information.
Reporting through Covisint
- Measures Group (all 25 are available)
- Individual Measures
- Data Mining
- Individual Measures
- Register each provider using their Individual NPI and Federal TIN.
(Note: Changes in TIN during the reporting calendar year may require multiple reporting, once under each TIN. Contact a Sales representative at 866-823-3958 for guidance)
- Each provider selects one measure group to report (if there are multiple providers in a practice they do not have to report the same measure group)
- Each provider selects 20 unique patients, of which greater than half or a minimum of 11 need to be Medicare Part B Fee-For-Service patients that meet ALL the requirements for the selected measure group (Refer to the Measure Group Guides on our Home Page once registered and logged into the web application for patient and reporting requirements)
- 4. Answer all the individual measures within the selected measure group for each of the patients, making sure to leave nothing blank. For most measures, there is the option to answer “Not Done/Unknown” or something similar. However, you cannot report “Not Done/Unknown” or “Performance Not Met” for all 20 patients for any given individual measure within the measure group.
Please refer to the question that explains the zero percent performance rates.
- Once you’ve collected the data on all 20 patients, log into the web application using your username and password and enter the patient data under the appropriate provider.
- If you have Internet connection in the exam room, you can skip using the data collection forms to collect the data and enter it directly into the web application at the time of the visit.
The fee for Covisint PQRS Enterprise for large provider groups or GPROs varies slightly depending on the number of submitted providers. This service is more costly than the web application. As such, we recommend it for larger practices (≥25 providers) to ensure cost effectiveness. There is an upfront data file processing fee and a per provider submission fee. Please contact a Covisint PQRS Sales representative at 866-823-3958 for additional pricing information on this reporting option.
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