Avoid the 2015 PQRS Negative Payment Adjustment
Rheumatologists and rheumatology health professionals who provide Medicare Part B Physician Fee Schedule–covered professional services need to be aware of a negative 1.5% payment adjustment under the Physician Quality Reporting System (PQRS) for individual eligible professionals (EPs) who do not submit data on PQRS quality measures to the Centers for Medicare and Medicaid Services (CMS) in 2013. The payment adjustment will be implemented in CY 2015.
Providers can submit data through traditional PQRS reporting methods to avoid the 2015 payment adjustment and potentially earn a 2013 incentive payment of 0.5%. The ACR’s Rheumatology Clinical Registry (RCR) is an easy-to-use tool for submitting data for PQRS reporting.
How to Register
Visit the ACR’s “RCR/Getting Started” page at www.rheumatology.org/Practice for registration instructions.
Requirements and Deadlines
- Report on the six measures contained in the RA Measures Group. To review the measures, go to www.rheumatology.org/Practice, click on “Measures in Detail” under the “Office Support/Physician Quality Reporting System” section.
- Report on 20 unique patients from Jan. 1–Dec. 31, 2013.
- 11 out of the 20 patients must be Medicare Part B patients. The other nine patients may be from any other payer.
All data must be submitted to the RCR by Jan. 31, 2014, 5:00 PM EST, to be eligible for the 2013 PQRS bonus payment and to potentially avoid the 2015 penalty.
CMS will issue incentive payments for PQRS in the fall of 2014. Penalties will be assessed in the fall of 2015.
For more information on PQRS, visit the “Office Support” section at www.rheumatology.org/Practice.
Questions? Contact ACR Staff!
The ACR staff is available to answer all of your PQRS reporting questions, including the process for reporting through the RCR. Please contact us at [email protected].
2013 PQRS Participation Review
The EPs, support staff, and group practices who submitted data for the 2012 PQRS program can now request an informal review of their reporting performance for CY 2012.
Who is eligible?
- EPs or group practices who did not earn the 2012 PQRS incentive payment when they believe they should have.
- EPs or group practices who believe the amount of their incentive payment was incorrect.
You can request a review on all 2012 reporting methods, including claims, qualified registry, qualified electronic health record, Group Practice Reporting Option (GPRO), and Web Interface (for groups of 100 or more EPs).
Informal requests can be made from November 1, 2013, until February 28, 2014, using CMS’ web-based tool, the Quality Reporting Communication Support Page. Please follow the directions below to submit an eligible request:
- Review requests will need to be submitted for each individual rendering National Provider Identifier (NPI) for each Tax Identification Number (TIN) under which the requestor submitted 2012 PQRS data. Groups that participated in the GPRO will need to have their main point of contact request an informal review for the TIN under which the GPRO submitted 2012 PQRS quality data codes or data.
- To submit the request, visit the Communication Support Page, https://www.qualitynet.org/portal/server.pt/community/commu nications_support_system/234, any time between now and February 28, 2014.
- Complete the mandatory fields in the online form. Each EP, point of contact, or support staff will need to complete the form in full or CMS will be unable to process the request. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.
Additional Resources
Additional information and resources are available from the ACR. Please contact us at [email protected].