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Continue to count on Covisint for your reporting under the MIPS program. Visit us regularly for additional information and program updates as we have them.

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

  1. The measure has a benchmark
  2. Has at least 20 cases; and
  3. 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 Virtual Measures Groups

CMS’ final rule for MACRA’s Merit-Based Incentive Payment System (MIPS) allows for Eligible Clinician’s to “pick your pace” by reporting a minimal amount of data to avoid penalty OR report more data for a 90-day period for the possibility of earning a small positive payment adjustment. With this in mind, and understanding that not all clinicians have adopted an EMR, Covisint has created these easy to use forms giving you the option to report “some data” using a BASIC measure set thus avoiding penalty or choose to report the ADVANCED measure set designed to aid in maximizing scoring*. In either case refer to the Individual Measure specifications for measure requirement criteria.

*To maximize potential incentives Eligible Clinicians must report at least six (6) quality measures including an Outcome or High Priority measure at a 50% reporting rate for at least 90-days in addition to other MIPS requirements.

Virtual Measures Group data collection forms:

Additional Resources:

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.

Documents

Formerly known as PQRI (Physician Quality Reporting Initiative), the Physician Quality Reporting System (PQRS) is a CMS Pay-For-Performance program that started in 2007. It began as a voluntary, incentivized program where eligible physicians report quality clinical data, collected during patient visits, to CMS. Participation in Physician Quality Reporting is now mandated and failure to report will result in penalties. There are multiple ways to report data for Physician Quality Reporting including:

  • 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
  • Web Interface – where groups report directly through the CMS portal

For additional information, visit the CMS website.

The Physician Quality Reporting System is designed to “support the delivery of consistent high-quality care, promote efficient outcomes in our healthcare system”, as well as to encourage appropriate documentation of data in a patient’s medical chart for follow up or reference at a later date/time. Reporting the requested data for the Physician Quality Reporting System promotes awareness by providers and practices about what data may or may not be fully or appropriately documented during their current processes.

There are no longer any incentives for PQRS reporting. Additional penalties or incentives based on the Value Based Modifier (VM), however, may apply. Refer to the VM question for more information.

Eligible Professionals (EPs) who successfully report PQRS in 2016 can avoid a -2.0% payment reduction in your 2018 fee schedule reimbursements. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.

CMS considers all result information related to your submission confidential to your practice and Covisint does not have access to this information. Historically this information is available in the fall of the year following the reporting year. See the next question on feedback reports for more.

Feedback Reports are available for every TIN, under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims, reported. Feedback Reports provide a breakdown of submission data, eligibility, payment and penalty information. These reports are not automatically provided and must be requested from CMS and your Medicare carrier.

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.

You can contact the Quality Net Help Desk at 866-288-8912 or http://www.qualitynet.org/. Additional information can also be found on the CMS website. You can also participate in CMS-sponsored National Provider Calls.

PQRS 2016 Reporting Requirements

Some of the changes for 2016 PQRS reporting are below. This list is not intended to be all inclusive. Refer to the CMS PQRS webpage for additional information.

  • There are three new measures groups – Cardiovascular Prevention, Diabetic Retinopathy, and Multiple Chronic Conditions. See question below for all available measures groups offered by Covisint in 2016.
  • Failure to report will result in a negative payment adjustment of -2.0% in 2018. 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 2016 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 MAV document for more information on the MAV process.
  • 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 2016 is the zero percent performance rule– see question specific to this topic below for additional information.
Eligible professionals should consider their practice, specialty, size, resources, and technology used when determining how to report. Refer to the CMS How to Get Started web page for reporting options and additional information. Covisint also offers free webinars and Q&A sessions throughout the year which you can attend. See the main page for a schedule.
Individual EPs can report through a registry using the individual measure reporting option or on a single measures group. Individual measure reporting requires 9 measures across 3 domains at a 50% reporting rate as well as one cross-cutting measure if they have at least one face-to-face encounter. EP’s reporting less than 9 measures will be subject to the MAV. Refer to our website for the document on the MAV process.

For measures group reporting individual EPs can report on one measures group for 20 applicable patients.

Refer to the CMS registry reporting made simple document for more information.

It depends on the reporting option. The 2016 requirement for the measure group reporting option is that greater than half or 11 out of 20 patients must be Medicare Part B FFS (primary, secondary or railroad).

The individual measure reporting option through a qualified registry requires reporting on only Medicare Part B FFS patients including primary, secondary and railroad.

A measures group is composed of six to ten individual measures and they are created and approved by CMS. They are only reportable by individual eligible professionals. Measures groups are not editable to include or omit specific individual measures. Covisint will offer 24 approved measures groups for 2016 reporting. The following measures groups are available:

Acute Otitis Externa (AOE) (2+) Hepatitis C (18+)
Asthma (5+) HIV/Aids (13+)
CABG (18+) Irritable Bowel Disease (IBD) (18+)
CAD (Coronary Artery Disease) (18+) Multiple Chronic Conditions (66+)
Cardiovascular Prevention (21+) Oncology (18+)
Chronic Obstructive Pulmonary Disorder (COPD) (18+) Optimizing Patient Exposure to Ionizing Radiation (OPEIR) (18-75)
CKD (Chronic Kidney Disease) (18+) Parkinson’s (18+)
Dementia (All ages) Preventive Care (50+)
Diabetes (18-75) RA (Rheumatoid Arthritis) (18+)
Diabetic Retinopathy (18-75) Sinusitis (18+)
General Surgery (18+) Sleep Apnea (18+)
Heart Failure (18+) Total Knee Replacement (TKR) (18-75)
No. Submitting more data than required will not earn additional incentive.
The zero percent rule implemented in 2011 continues for 2016 Physician Quality Reporting. Whether reporting individual measures or a measures group, measures with a 0% performance rate (100% for inverse measures), are not considered successfully reporting.

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. 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.

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 (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). If there are NO eligible patients for a given measure within a measures group the result would be a 0/0 or NULL performance and would be considered acceptable reporting.

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.

The measures you choose should be based on your specialty and patient population. There are nearly 300 individual registry measures from which to choose. Consider measures you already track for other programs however make sure the specifications are identical and that you are measuring the same thing. Other considerations and information on measure selection can be found on the CMS PQRS measure codes webpage.
In 2010 CMS added the group practice reporting option or GPRO. Groups of eligible professionals reporting under a single tax id have the option to self-nominate to report as a group instead of individually. There are several ways to participate including through a qualified GPRO registry such as Covisint. Groups who would like to report as a GPRO in 2016 must register by June 30, 2016. Be sure you understand exactly what is required, including cost and ability to provide required data, before you make the election as you can’t change your mind after the deadline has passed.
CMS began applying a value based modifier (VM) in 2016 based on 2013 PQRS reporting.  Both cost and quality data composites are to be included in calculating payments for physicians. All physicians who participate in Fee-For-Service Medicare will be impacted by CMS’ emphasis on reporting quality data through PQRS and by 2017 will be affected by the value modifier. Click here for more on the 2016 value-based payment modifier.
Yes, these are separate incentive/penalty programs with different reporting requirements and penalties may be applied for both.
No, the e-Prescribing incentive program is over.
No. However, documentation in the patient’s chart is required. We recommend that you retain a copy of the source documents you used to determine reported patients for auditing purposes. EP’s are responsible to CMS for any audit requirements.

Reporting through Covisint

  1. Measures Group (there are 24 available)
  2. Individual Measures (reported by individual EPs through the Covisint web portal)
  3. Data Mining Analysis
    1. GPRO
    2. Individual EPs
Yes. You can submit both methods but CMS will not combine two methods in order to meet the requirements. CMS will review all submissions and accept the submission that is most beneficial to the provider.
Yes, Covisint is a qualified registry and can report on behalf of a group who self-nominated before the June 30, 2016 deadline choosing the GPRO Registry reporting option. Covisint analyzes your claims and available clinical data files to identify applicable measures and performance for your physician group. A GPRO cannot report through our web tool. Contact sales directly at 866-823-3958 for more information or to sign up.

  1. 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)
  2. 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)
  3. 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.
  5. 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.
  6. Review your PQRS Submission Summary report to verify there are no 0% performance rate issues.
  7. Submit
  8. 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.
No. You do not need to re-register to access the Covisint web application. Your login credentials will carry over each year. Use your same username and password to login to the 2016 web application. If you cannot remember your username and/or password please contact the Covisint PQRS Support Team at 866-823-3959 to have it reset.
It is $299 per provider to submit using the Covisint PQRS web application. There is no registration fee and no upfront costs. The one-time payment of $299 per provider is paid at the time of submission using any major credit card. Discounts may be available through your state medical society. Physician organizations can contact Covisint for discounted pricing.

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.

Yes. You will need to contact a Covisint PQRS Sales representative at 866-823-3958 to receive a coupon code to use at each submission.
The Covisint web application will close for 2016 PQRS reporting on March 3, 2017. Check our website for any changes to this date which is subject to change as required. Be sure that your submission is completed in time to allow for any necessary corrections or changes. Once we close for the reporting year all submissions are considered FINAL. Covisint strongly recommends you do not wait until the final weeks to report.