CMS issued the final rule on November 27, 2013, that updates the quality reporting initiatives for next year and includes the implementation of the Value-Based Payment Modifier that will affect the payment rates to certain groups with 10 or more providers, based on the quality and cost of care they furnish to Medicare beneficiaries.
The major changes for the 2014 PQRS program include:
- Total of 284 measures in 2014 (up from 259 in 2013)
- 9 individual measures to be reported via claims and registry (up from 3)
- Threshold change for both individual EPs and groups reporting individual measures via registry to 50% of the eligible professional’s (EP’s) applicable patients (down from 80%)
- Option to report on claims-based measures groups eliminated
Furthermore, the rule established the following:
- EPs and group practices that meet the criteria for 2014 PQRS incentive will automatically avoid negative payment adjustment in 2016
- EPs using the claims and registry-based reporting mechanisms as well as the newly implemented qualified clinical data registry reporting mechanism may report 3 measures on 50% of their applicable patients to avoid 2016 PQRS payment adjustments
- The option to report on claims-based measures groups to avoid future payment adjustments has been eliminated
For groups who elect to participate using the Group Practice Reporting Option (GPRO) in 2014, the rule included:
- Creation of a new reporting mechanism, the certified survey vendor reporting mechanism, that allows a group of 25 or more EPs to count reporting of Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CG CAHPS) survey measures towards meeting criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment
For more information about participating in PQRS in 2014, visit the CMS PQRS website.
Source: HITECH Answers