Need to know: PQRS registry reporting in 2016


As we kick off the final year of the Physician Quality Reporting System (PQRS) in 2016, there may be some physicians and other PQRS eligible providers looking forward to saying goodbye to this program forever. Those sentiments may be a bit premature however, since recent legislation has indicated that while the PQRS program in its current form will be ending, there is a strong possibility that portions of it will continue as part of the Merit-Based Incentive Payment System (MIPS), introduced under MACRA legislation.

The upside to the potential reincarnation of PQRS in future Medicare payment reform programs is that the work that physicians put into PQRS participation now will not be wasted time or effort. As an eligible professional or group practice, one option you have to report quality measures for PQRS is using a qualified registry. Centers for Medicare and Medicaid Services (CMS) designates “qualified registries” as entities that can collect clinical data from providers or group practices and submit that data to CMS on behalf of PQRS participants. Early indications from CMS suggest that MIPS will encourage physicians to report quality data to CMS through either a qualified registry or EHR technology, rather than claims, which means that choosing this option in 2016 is a step in the right direction as it relates to preparing for MACRA.

Individual measures reporting requirements for 2016

Individual eligible professionals and group practices may satisfactorily report for PQRS in 2016 by meeting the following criteria:

  • Report on at least 9 measures covering 3 National Quality Strategy domains for at least 50% of applicable Medicare Part B patients. If you see at least one Medicare patient in a face-to-face encounter in 2015, then you must also report on at least one cross­-cutting measure.
  • Eligible professionals who submit quality data for fewer than 9 PQRS measures for at least 50% of their patients or encounters eligible for each measure OR who submit data for measures covering fewer than 3 domains for at least 50% of their patients or encounters eligible for each measure will be subject to the CMS Measure Applicability Validation (MAV) process.
  • Measures with a 0% performance rate, meaning you do not report any patients who meet denominator and numerator requirements, will not be counted.

Group practices will need to register with CMS prior to June 30, 2016 to report via qualified registry under the Group Practice Reporting Option.

Measures groups reporting requirements for 2016

Individual eligible professionals who wish to report PQRS using a qualified registry also have the option to report on a single measures group instead of 9 individual measures.

  • To report measures groups satisfactorily, eligible professionals must report at least 1 measures group on a 20-patient sample, a majority of which (at least 11 out of 20) must be Medicare Part B beneficiaries.
  • For this reporting mechanism, providers should review measure specifications using the 2016 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual.

New resources available in 2016

CMS made a big push to provide additional resources for PQRS this year, specifically for the claims and registry reporting mechanisms. These new resources should make it easier to select quality measures for reporting in 2016:

  • Quickly located individual measure specifications using the new PQRS web tool. The web-based measures list tool allows users to search for measures using a number of criteria and then access detailed information about each measure, including measure specifications materials.
  • Measure flow sheets for each 2016 individual quality measure can now be found after the narrative measure specifications in the 2016 PQRS Individual Claims Registry Measure Specification Manual.
  • A complete list of the numerator and denominator codes for 2016 PQRS Individual Claims and Registry measures can now be found in one easy-to-download Excel spreadsheet. This supportive document may be used to find codes that will be billed by individual eligible professionals or group practices, billing software, or vendors that report on 2016 PQRS Individual Claims and Registry Measures.

It is important for physicians and other PQRS eligible providers to participate in 2016 for many reasons, but if the payment penalties aren’t enough then perhaps preparing for Medicare payment reform requirements will help make it worth the time for your organization. For those who want to participate, work directly with your registry—or quality improvement vendors like Able Health that facilitate registry reporting—to make PQRS reporting as simple as possible both now and in the future.

Further reading:
How using the MIPS 90-day reporting period will increase your 2017 Composite Score
Avoiding a penalty in 2018 MIPS: the nuts and bolts

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