There are several different reporting options from which a PQRS participant may choose in order to get credit toward earning the Medicare incentive (bonus) and/or avoiding the noncompliance payment adjustment (penalty). Also, check out the 2014 PQRS At-a-Glance chart for a quick explanation of the reporting options/requirements and an explanation of the incentive and payment adjustment.
For those reporting as individual eligible professionals, the options are:
Providers may collectively report as groups, known as the Group Practice Reporting Option (GPRO). Their options for reporting are:
Claims reporting is the most frequently used process for urologists. It involves reporting extra CPT Category II codes along with regular billing CPT codes and diagnosis codes on electronic or paper claims submitted to Medicare. Medicare then forwards these claims files to the PQRS processor. To receive the incentive, you must report at least nine measures covering at least three domains of care, but to avoid the penalty, you only need to report on three measures. Regardless of how many measures you report, you must report on at least 50 percent of your applicable patients for each measure.
Registry reporting may be used by both individuals or groups. It is accomplished by contracting with a CMS approved data processing service that can compile your patient claims data and generate reports on your behalf directly to the PQRS processor. You can use a registry to report either individual measures or a measures group. If you choose to report individual measures, you must report at least nine measures covering three domains of care to receive the incentive or only 3 measures to avoid the penalty. Regardless of the number of measures you choose, you must report on at least 50 percent of your applicable patients for each measure. If you report using a measures group, you are only required to report on 20 patients (11 of whom must be Medicare patients). However, you must report each measure in the measures group for each of the 20 patients.
CMS annually posts a list of authorized registries. However, the AUA offers its members PQRSwizard, a urology-specific PQRS-authorized registry, where participants may report on either individual measures or measures groups. To learn more about or to sign up and use, log on to the affinity program page. Additionally, the American College of Surgeons allows members to report on the PQRS Perioperative Care Measures Group through the Surgeon Specific Registry.
Direct EHR vendors are those vendors that are certifying an EHR product which will directly submit a provider's or practice's PQRS measures data to CMS in the CMS-specified format(s) on the provider's or practice's behalf. If providers or practices are submitting quality measure data directly from an EHR system, they must register for an IACS account. Check with your EHR vendor to see if they are a direct EHR vendor.
EHR Data Submission Vendor (DSV) is an entity that collects an EP's or group practice's clinical quality data directly from the EP's or group practice's EHR. In other words, participants submit their data to the DSV, and the DSV submits everything to CMS. Check with your EHR vendor to see if they provide this service.
A Qualified Clinical Data Registry (QCDR), new in 2014, is a CMS-approved entity (such as a registry, certification board, specialty society, etc.) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. The data submitted to CMS via QCDR covers quality measures across multiple payers and is not limited to Medicare. Only individuals may report via a QCDR. A list of CMS-designated QCDRs will be available on the CMS PQRS website in the fall of 2014. The AUA is developing a QCDR, the AQUA Registry, which will be available in future years.
The GPRO Web Interface requires that users register their intent with CMS by September 30, 2014. Group practices of 25-99 individual eligible professionals must report on all measures included in the Web Interface AND populate data fields for the first 218 consecutively ranked and assigned beneficiaries in the order in which they appear in the group's sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 218, then report on 100 percent of assigned beneficiaries. However, if the practice elects not to do this, they have the option to choose to have all 12 CG CAHPS summary survey modules reported on its behalf via a CMS-certified survey vendor in addition to reporting 6 measures covering at least 2 domains of care using a qualified registry, direct EHR product, EHR data submission vendor, or GPRO Web Interface as a reporting mechanism.
Group practices of 100+ eligible professionals must report on all measures included in the Web Interface AND populate data fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group's sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100 percent of assigned beneficiaries. In addition, the group practice must report all CG CAHPS summary survey modules via CMS-certified survey vendor.
A CMS-certified survey vendor is a new reporting mechanism available to group practices taking part in PQRS under the GPRO beginning in 2014. This option is available to group practices of 25 or more eligible professionals wishing to report the CG CAHPS summary survey modules. The data collected on these measures will be submitted on behalf of the group practice by the CMS-certified survey vendor, the results of which will subsequently be posted on the Physician Compare website. The CG CAHPS summary survey modules will be considered the equivalent of 3 individual measures and 1 domain of care. Therefore, group practices that register for this method of reporting will need to report on at least 6 additional measures covering at least 2 additional domains via qualified registry, direct EHR product, or EHR data submission vendor. The CG CAHPS summary survey module is required for all group practices of 100+ eligible professionals reporting under the GPRO and using the GPRO Web Interface.
More information on reporting options can be obtained from the Centers for Medicare & Medicaid Services website.