Getting your “cash back bonus”
Interested in a “cash back bonus”? The Discover Card has used this marketing ploy successfully for years – people opt-in by using their credit card and they earn a bonus based on the money they’ve spent. With the Physician Quality Reporting Initiative (PQRI), Medicare jumped on the “cash back bonus” bandwagon in 2007, but less than 10% of the eligible providers nationwide – and less than 2% of chiropractors - have successfully reported and received the bonus.
What is PQRS?
It remains a voluntary program that creates financial incentives for providers to report certain quality measures for Medicare Part B services. These incentive payments are issued separately the year following the reporting. CMS believes these quality initiatives will empower providers and consumers with information that would support the overall delivery of quality care. Consumers will have access to provider quality measures by 2014. Ultimately, CMS believes these quality measures will help support a new payment system based on quality rather than quantity.
While participation is voluntary, beginning this year providers who do not participate or are unsuccessful participants will see their Medicare reimbursements decreased by 1.5% through 2015 and 2% in 2016. The Patient Protection and Affordable Care Act (PPACA or ACA) makes reporting mandatory by 2015.
Quality Measures are developed by many organizations within the healthcare industry. The criteria for satisfactory reporting of claims-based quality measures include:
- Reporting on at least 3 PQRS measure (or 1-2 if less than 3 measures apply to the provider)
- Report each measure for at least 50% of the providers Medicare Part B patients
There are currently 2 measurements open to chiropractic in 2013: pain assessment; and function outcome assessment.
Pain assessment (#131)
Percentage of patients aged 18 years and older with documentation of a pain assessment (including location, intensity and description) through discussion with the patient include the use of a standardized tool on each visit AND documentation of a follow-up plan.
Functional Outcome Assessment (#182)
Percentage of patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool and documentation of a care plan based on identified function outcome deficiencies.
Physicians do not have to register or sign-up to participate in PQRS. The submission of quality data codes for the 2013 quality measures through claims, or a qualified registry will indicate your intent to participate.
PQRS is frequently confused with the EHR program’s Clinical Quality Measures. Reaching Meaningful Use with your EHR does NOT equate to successful PQRS reporting. They are separate programs and failure to successfully participate in both will impact your Medicare reimbursements.
Confused? Frustrated? Need help in getting started? Attend one of our Lunch and Learn Webinar programs and see just how easy it is to get started – and become a successful reporter or PQRS measures!