Every provider can avoid the 1.5% PQRS reporting penalty

July 18th, 2013 by Rod Baird

Earlier blog posts of mine have discussed PQRS reporting strategies and the need for better measures for LTC physicians/extenders. Today, I want to review the minimum steps every provider treating Medicare patients needs to take to avoid a 1.5% payment cutback in 2015.

Report one valid measure or one valid measures group, or one instance of a measure or measures group can be submitted according to the requirements set forth in the 2013 PQRS measure specifications

The highlighted language comes directly from a CMS 2013 PQRS Registry Vendor Slide Deck (see slide 15). This “small detail” is not elaborated on the standard PQRS information, so easily could be misunderstood. We were skeptical that the hurdle was so low (one instance only, not one full measure — i.e. reporting of 50% of all eligible patients). Consequently we called the Quality Net Help Desk, which confirmed that one instance was all that was required.

So, if a provider submits a single valid CPT II code associated with a PQRS measure on a claim for a 2013 Medicare encounter, they avoid the penalty. Could it be any easier?

If you see geriatric patients in an office, nursing home, ALF or at home, Advanced Care Planning (PQRS measure 47) is extremely simple to report. Place one of these CPT II codes on your claim along with an E&M code for the encounter:

1123F: Advance Care Planning discussed and documented, advance care plan or surrogate decision maker documented in the medical record; or

1124F: Advance Care Planning discussed and documented in the medical record, patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan; or

1124F: Patient’s cultural and/or spiritual beliefs preclude a discussion of advance care planning; or

1123F with 8P: Advance care planning not documented, reason not otherwise specified.

Reporting any of these codes, along with an E&M code, once during 2013 avoids losing 1.5% on your 2015 Medicare rates. Could you make any better investment? You do need to document the patient’s status in their Medical Record to meet the specification.

This strategy works for any individual. Groups require slightly different strategies, and any group of 100 or more still has a separate quality reporting requirement to avoid the additional 1% Value Based Purchasing payment penalty.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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