We have been actively following PQRS developments with a watchful eye for the most efficient and effective way for Medicare providers to avoid the 2015 PQRS penalty. An option that may be a good solution for both group practices and individual providers is the CMS-calculated administrative claims reporting option. This option was presented by CMS in response to the cumbersome process that providers were faced with when attempting to report quality measures via claims, or registries, or EHR systems. Because this participation option is relatively new – the specifics of the process are still a bit vague. Even as recently as June 3, 2013, CMS published an update indicating that more details will be published as they become available. In this update, CMS stated the following:
Administrative claims is a new reporting mechanism to avoid the 2015 PQRS payment adjustment. Under this option, CMS will analyze claims data to determine which measures were satisfactorily reported for the 2013 program year. More information regarding the CMS-calculated administrative claims-based reporting option and how eligible professionals can elect this option will be posted on the CMS website as it becomes available.
If this entire process of understanding PQRS reporting options has you confused – it is likely because CMS itself is still in the process of figuring out the system! That being said – we do know the following about the process:
- Group providers (of all sizes) and individual providers are eligible to sign up for the CMS-calculated administrative claims reporting option.
- To use this reporting options, providers must actively self-nominate/register to participate. The registration period will be from July – October 15, 2013.
- This reporting option will not enable providers to earn the .5% PQRS incentive payment that is still on the table; however, it will allow them to avoid the 1.5% PQRS penalty scheduled for 2015.
- Per CMS: “CMS-calculated administrative claims reporting option requires no effort beyond signing up.” – (re: no need to report on the new “G” codes that were created specifically for PQRS).
Since the details of this process are still being ironed out, CMS has yet to fully instruct on how providers enroll, which measures will be targeted, and what exactly qualifies as satisfactory.
For more details, we recommend signing up for the upcoming National Provider Calls on the topic.
- PQRS and eRx Incentive Program Payment Adjustment National Provider Call: June 18, 1:30 PM
- Choosing Your PQRS Group Reporting Mechanism and Implications for the Value-based Payment Modifier: July 31, 2:30 PM
To register for either or both of these calls, visit the following link: https://www.eventsvc.com/blhtechnologies.
For additional information on the CMS-calculated administrative claims reporting option, visit CMS’ News and Announcements Page: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/News.html.