Changes are coming for the Physician Quality Reporting
System (PQRS). Participation in 2015 means avoiding a 2-percent cut to your
Medicare payments in 2017.
"The biggest errors in the past have been using
measures that do not apply to a specific patient."
Additionally, in 2015 bonuses will no longer be given for
successful participation.
Many optometrists have taken part in the program; as of 2012, at least 32 percent of eligible ODs were participants, according to data from the Centers for Medicare & Medicaid Services.
There's a downside to nonparticipation. On Nov. 10, CMS sent letters to ODs and other doctors who did not participate in PQRS in 2013, informing them they would be subject to a 1.5 percent payment penalty in 2015.
AOA informed members earlier this year of the steps they should take in 2014 to earn PQRS bonuses and avoid penalties in 2016.
Many optometrists have taken part in the program; as of 2012, at least 32 percent of eligible ODs were participants, according to data from the Centers for Medicare & Medicaid Services.
There's a downside to nonparticipation. On Nov. 10, CMS sent letters to ODs and other doctors who did not participate in PQRS in 2013, informing them they would be subject to a 1.5 percent payment penalty in 2015.
AOA informed members earlier this year of the steps they should take in 2014 to earn PQRS bonuses and avoid penalties in 2016.
PQRS changes that affect ODS
The AOA wants ODs to be aware of coming changes to PQRS in 2015. Previously, eligible providers could earn a bonus for successfully reporting on PQRS measures. No such bonus exists next year.
However, ODs who participate will prevent a 2-percent loss from their total Medicare payments in 2017, Rebecca Wartman, O.D., a member of the AOA Third Party Center Coding Committee, notes.
Most ODs use claims-based reporting to participate in PQRS quality reporting. For 2015, AOA successfully protected the claims-based reporting option for many measures that ODs report.
One measure has been discontinued for 2015: "Diabetic Retinopathy: presence or absence of macular edema and level of retinopathy." This means that ODs have nine instead of 10 available quality measures to do their reporting.
Six eye-care-specific measures can still be filed, Dr. Wartman says. There are also three "cross cutting" measures available to ODs: tobacco use and counseling, hypertension and follow up, and medication listing.
To avoid the 2-percent penalty in 2015, ODs must:
Report accurately on nine measures for applicable
patients 50 percent of the time.
Report on at least one quality measure from the
"cross cutting" measure set. It is important to note that the cross
cutting measure counts toward the nine total required measures.
If fewer than nine measures apply, eligible providers can
still participate.
ODs should be aware that reporting fewer than nine measures would trigger the Measure-Applicability Validation (MAV) review. CMS conducts this review to determine whether a physician should have reported additional measures
ODs should be aware that reporting fewer than nine measures would trigger the Measure-Applicability Validation (MAV) review. CMS conducts this review to determine whether a physician should have reported additional measures
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