Do the 2016 PQRS reporting requirements have you totally overwhelmed and confused?
With Covisint PQRS you can confidently avoid the 2018 payment adjustment of -4.0% to -6.0% depending on the size of the organization. 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.
Refer to the CMS links below for additional information
How to get Started
Registry Reporting made Simple
Value-Based Payment Modifier
- Paper and electronic data collection methods
- Web-based application access and data entry
- Easy and Quick … The measures group option only requires 20 patients
- HIPAA-compliant database
- Automated data submission
Merit Based Incentive Payment System (MIPS)
On October 14, 2016, CMS finalized MACRA’s new Medicare Quality Payment Program (QPP) rules. Here are some of the highlights:
- Clinicians can choose to report to MIPS for a full 90-day period or, ideally, the full year, and maximize the MIPS eligible clinician’s chances to qualify for a positive payment adjustment.
- Clinicians can choose to report MIPS for at least a full 90-day period and report: (a) more than one quality measure, and (b) more than one improvement activity, and (c) more than the required measures in the advancing care information performance category and avoid a negative MIPS payment adjustment and possibly receive a positive MIPS payment adjustment.
- Clinicians can choose to report one measure in the quality performance category; one activity in the improvement activities performance category; or report the required measures of the advancing care information performance category and avoid a negative MIPS payment adjustment. Alternatively, if MIPS eligible clinicians choose to not report even one measure or activity, they will receive the full negative 4 percent adjustment.
- MIPS eligible clinicians can participate in Advanced APMs.
For 2017, many small practices will be excluded from new requirements due to the low volume threshold, which has been set at less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients.
For full participation in the Quality Performance category, clinicians will report on six quality measures including at least one Outcome or High Priority measure if an outcome measure is not available, or one specialty specific or subspecialty specific measure set. Under the 2017 transition year, for the quality category, clinicians who submit at least one out of six quality measures will meet the MIPS performance threshold of 3 points – enough to avoid a negative payment adjustment.
Individual MIPS eligible clinicians or groups submitting data on quality measures using qualified registries must report on at least 50 percent of the MIPS eligible clinician or group’s patients that meet the measure’s denominator criteria, regardless of payer for the performance period. In other words, CMS expects to receive quality data for both Medicare and non-Medicare patients. For the transition year, MIPS eligible clinicians whose measures fall below the data completeness threshold of 50 percent would receive 3 points for submitting the measure.
If fewer than six measures apply to the individual MIPS eligible clinician or group, then the MIPS eligible clinician or group would be required to report on each measure that is applicable. CMS defines “applicable” to mean measures relevant to a particular MIPS eligible clinician’s services or care rendered. The MIPS validation process will vary by submission mechanism. For claims and registry submissions, CMS plans to use the cluster algorithms from the current MAV process under PQRS to identify which measures an MIPS eligible clinician is able to report.
For the 2017 transition year, if the measure is submitted but is unable to be scored because it does not meet the required case minimum (20), does not have a benchmark, or does not meet the data completeness requirement (at least 50% reporting rate), the measure will receive a score of 3 points. Measures that were submitted or calculated that met the following criteria will receive 3 to 10 points based on performance compare to the benchmark.
- The measure has a benchmark
- Has at least 20 cases; and
- Meets the data completeness standard (generally 50 percent)
Submission of the Advancing Care Information performance category or the Improvement Activities category can be done via the Covisint registry. Look for these reporting options to be available within the Covisint web application in future releases.
For full participation in the Advancing Care Information performance category, MIPS eligible clinicians will report on five required base score measures. For more click on the Advancing Care Information Fact Sheet under the documents tab.
For full participation in the Improvement Activities performance category, clinicians can engage in 3 combinations of activities based on weight to earn the highest possible score of 40. For more on the Improvement Activities refer to the fact sheet under the documents tab.
Click to learn more about the new QPP program, or to explore measures.
Covisint Enterprise Analysis Service
For organizations that need assistance aggregating their Quality Measure data Covisint offers an analysis service. The Covisint MIPS Enterprise service allows organizations to report MIPS Quality Measures as either individual eligible clinicians or as a group (GPRO) with data aggregated across the group TIN. By extracting your billing and clinical data from your source systems and uploading to Covisint via a secure file transport system Covisint can then analyze the data identifying measure eligible encounters and performance.
Results are provided via reports through a secure portal where they can be viewed and downloaded on demand as often as updated data is provided. The Covisint Dashboard provides the ability to track measures and performance throughout the year driving improved performance with actionable information. All reports use drilldown capabilities where appropriate and are designed to be immediately useful for quality improvement to either your data collection infrastructure or care delivery workflow.
Contact us at 866.823.3958 or [email protected] to learn more or sign up.