It’s not too late to avoid PQRS penalty and earn incentive

Even though it is nearly November and you may not have reported Quality Data Codes on claims this year, it’s not too late to avoid the penalty OR to earn the incentive.

Getting straight to the point, the simplest method to avoid the 2015 PQRS Payment Adjustment (penalty) is to submit an appropriate Quality Data Code (QDC) on one eligible claim in 2013:

The PQRS Incentive for 2013 is 0.5% of PFS Medicare Part B total allowed charges. The penalty is 1.5% off of 2015 PFS Medicare Part B total allowed charges. If your providers do nothing else, they should ensure that they avoid the penalty by taking this simple step of reporting on one measure-qualifying claim.

Suggestion: Report PQRS measure #130 (Documentation of Current Medications in the Medical Record) via a claim on your next Medicare PFS patient.

Measure #130 applies to patients, aged 18 and over, for whom the Eligible Professional (EP) attests to documenting a list of current medications, including ALL prescriptions, over-the-counter medications, herbal preparations, and vitamin/mineral/dietary (nutritional) supplements. The medication list must include medication name, dosage, frequency, and route of administration.

  • Add Current Procedural Terminology Code (CPT)[1] G8427 to the next Medicare PFS office visit claim when medications are documented.
  • Add the ICD-9 codes, but leave the charge as $0.00.
  • The payer may return the remit code N365 line-item rejection, which would serve as an indicator that the provider’s PQRS participation counted.

What was that October 15 Deadline anyway?

October 15 was the deadline for two things:

Self-Nomination for Group Practice Reporting Option (GPRO) – this was optional, except for groups of 100+ providers*. Individual reporting is always an option to earn an incentive.

Electing for “Administrative Claims” – for individuals and groups, this was one way to avoid the 2015 penalty. The 1-1-1 method we describe above is an alternative, and is available until December 31, 2013.

*Groups of 100+ billing under the same TIN: if you did not self-nominate as a GPRO by the October 15 (18) deadline, we recommend that you sign up for a free eligibility call with one of our PQRS Subject Matter Experts to review your situation and consider your options. See below under eClinicalWorks PQRS EHR Reporting Services for instructions in setting up a PQRS eligibility call.

Reference: eClinicalWorks PQRS Consulting Newsletter #2 – October 2013

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