PQRS FAQs

ACA Medicare Physician Quality Reporting System (PQRS) Frequently Asked Questions (FAQs):
Helping Doctors of Chiropractic Improve the Quality of Patient Care

The Centers for Medicare and Medicaid Services’ (CMS’) Physician Quality Reporting System (PQRS – formerly referred to as PQRI) will continue in 2015. Beginning January 1, 2015, physicians who report certain quality measures will no longer be eligible for a payment incentive, but will be subject to a payment adjustment if they are not successfully and satisfactorily participating in the program. To assist doctors of chiropractic who participate in this program, the ACA has compiled a list of the frequently asked questions and resources to help familiarize the chiropractic profession with the measures relevant to their practice and facilitate the data collection required to successfully report. 

Q. What is the Physician Quality Reporting System?

A. The Physician Quality Reporting System (PQRS) represents CMS’ effort to implement a quality measure reporting program for Medicare providers.

 

Q. Is participation in PQRS mandatory?

A. The Patient Protection and Affordable Care Act (PPACA) made participation in PQRS mandatory, beginning in 2015. For clarification, CMS ruled in 2012 that, if a provider is not successfully participating in PQRS during the 2013 reporting period (Jan.1 – Dec. 31, 2013), their reimbursement will be decreased by 1.5% in 2015.  In 2016 and beyond, reimbursement will be decreased by 2% and will be based on performance two years prior.

 

Q. Why should I participate in PQRS?  

A.  Chiropractic participation in the PQRS is critical, as it demonstrates to CMS and the rest of the healthcare community that the chiropractic profession is serious about quality care improvement.  It is through the enhancement of quality patient care that the chiropractic profession will enhance its involvement in our nation’s health care delivery system.

 

Q. To which Medicare providers does PQRS apply?

 A. The program applies to:

·Doctor of Medicine

·Doctor of Osteopathy

·Doctor of Podiatric Medicine

·Doctor of Optometry

·Doctor of Oral Surgery

·Doctor of Dental Medicine

·Doctor of Chiropractic

·Physician Assistant

·Nurse Practitioner

·Clinical Nurse Specialist

·Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant)

·Certified Nurse Midwife

·Clinical Social Worker

·Clinical Psychologist

·Registered Dietician

·Nutrition Professional

·Audiologists (as of 1/1/2009)

·Physical Therapist

·Occupational Therapist

·Qualified Speech-Language Therapist (as of 7/1/2009)

 

Q. When does the 2014 PQRS reporting period begin and end?

A. For 2014, the program begins on January 1, 2014 and concludes December 31, 2014.

 

Q. What are the requirements for participating in the PQRS program?

A. It is not necessary to register to participate in the PQRS program, but participants must have a National Provider Identifier (NPI) number in order to participate and must treat Part B beneficiaries.

 

Q. How does the incentive bonus payment work?

A. You can receive up to a 0.5% bonus, based on all Medicare allowed charges for dates of service January 1, 2013 through December 31, 2014.  This includes deductibles and co-insurance as well as, where Medicare is the secondary payor, the total allowed charges and not just the portion paid by Medicare.

 

Q. What is meant by the 50 percent threshold for satisfactory PQRS Reporting?

A. This means that, during the 12-month reporting period, you have satisfactorily reported the measure for at least 50 percent of the Medicare Part B eligible visits (i.e., where the patient is at least 18 years old and a spinal CMT code was billed).  That said, the ACA strongly recommends that you report PQRS measures on every visit to increase the chances of meeting the satisfactory reporting requirements for the incentive and to avoid the payment adjustment.

 

Q.  What are considered appropriate assessment tools for Measure #131, the pain assessment measure?

A.  An assessment tool that has been appropriately normalized and validated for the population in which it is used. Examples of tools for pain assessment include, but are not limited to, Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS), and Visual Analog Scale (VAS).

 

Q.  What are considered appropriate assessment tools for Measure #182, the functional assessment measure?

A.  An assessment tool that has been appropriately normalized and validated for the population in which it is used. Examples of tools for the functional outcome assessment measure include, but are not limited to, Oswestry Disability Index (ODI), Roland Morris Disability/Activity Questionnaire (RM), and Neck Disability Index (NDI) and Physical Mobility Scale (PMS).

Please Note: The use of a standardized tool assessing pain alone, such as the visual analog scale (VAS), does not meet the criteria of a functional outcome assessment standardized tool.

 

Q.  Why do the CMS regulations say that provider have to report on a minimum of nine (9) measures?

A.  For 2014, CMS increased the number of individual measures a provider must report on from three (3) to nine (9), if they want to qualify for a PQRS incentive payment. However, because DCs only have three measures available for reporting, we only have to report on those three.

 

Q. Is there a charge amount associated with reporting PQRS quality data codes (G-codes)?

A. CMS strongly encourages all eligible professional to submit quality data codes (PQRS G-codes) with a line item charge of one cent ($0.01).  Please note that the beneficiary is not liable for this nominal amount.  When the claim is submitted to the Medicare Administrative Contractor (MAC), the PQRS code line will be denied but will be tracked in the National Claims History (NCH) for analysis.

Please note: Effective April 1, 2014, PQRS will issue different Remittance Advice (RA) codes for providers that bill on claims using $0.01 vs. $0.00. 

HIGHLIGHTED RESOURCES FROM CMS

CMS PQRS Frequently Asked Questions

CMS Medicare Physician Compare Initiative – CMS is required to post the names of eligible professionals and group practices who satisfactorily reported under the PQRS. This information should be publically available by January 1, 2013. For more information about the Physician Compare Website, click here.

To access all available PQRS educational resources, visit www.cms.hhs.gov/PQRS on the CMS Web site and click on the Educational Resources tab.