“How to Avoid PQRS Cuts in 2015”

“How to Avoid PQRS Cuts in 2015”
December 2012
If physicians sign up for the administrative claims-based reporting option in 2013,which is the only
year it will be available, CMS will pull the data from the physician claims, which will avoid the
1.5% payment adjustment in 2015.This requires no additional work for the physician. The
claims-based reporting option will allow CMS to calculate your quality based on overall claims
from your patients. For example, CMS will be able to determine whether a physician monitored
all patients on Coumadin each month, based on the physician billing for a PT/INR. This would
meet the criteria for monthly INR monitoring for patients on warfarin. The steps required to elect the
administrative claims-based option:
1. Compile the necessary data for an election statement, which includes the physician’s name,
practice name, tax ID, NPI, and contact information. For a group practice, include the group
practice business name, contact information, and group tax ID. A group practice is one with two or
more eligible professionals under the same tax ID.
2. The rules state that ACO’s cannot use the administrative claims-based reporting but must report
PQRS through the group practice reporting options of the web interface.
3. Submit the information on-line.
The deadline for choosing the administrative claims-based reporting is October 15, 2013.
Remember that failure to report PQRS will cost. In addition to the 1.5% pay cut, groups with 100+
eligible providers will face an additional 1% cut because of the value-based payment modifier. This
modifier will use PQRS data to adjust Medicare rates up or down by 1%, so if a group does not
report PQRS, its payments will be cut by a total of 2.5%.We wish everyone “Happy Holidays” and
look forward to working with you in 2013.
If you have any questions or need additional information regarding this article please contact Cindy Tipton-Cain @
Cindy_Cain@MED3000.com.
MED3OOO is a leading provider of healthcare management and technology services that improve outcomes for providers, health plans, and the patients and employees they serve. The Company provides a
broad array of proprietary solutions for physician groups, hospitals, health systems, health risk organizations, and state and local municipalities, enabling them to reach their maximum potential with respect to
operational, financial, and clinical results. Through the integrated application of systems, operations, analytics and domain expertise, MED3OOO serves as the premier strategic operations partner for he
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healthcare community. The Company’s depth of knowledge across its services, economies of scale, infrastructure, and ability to offer and manage disparate information systems provide MED3OOO with a distinct
competitive advantage in the rapidly evolving healthcare industry. Each of the components of MED3OOO’s product and services suite is a critical competency for moving toward the delivery of accountable care.
For more information regarding Coding and Compliance, or other services please contact:
Cindy Tipton-Cain
404-310-4835
Cindy_Cain@MED3000.com
MED3OOO, Inc.
680 Andersen Drive
Foster Plaza 10
Pittsburgh, PA 15220
412-937-8887
Toll Free: 1-888-811-2411 www.MED3OOO.com
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