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How to Avoid PQRS and Value Based Modifier Penalties

  Sep 3rd, 2015   -     News   -  

Medicare’s Physician Quality Reporting System (PQRS) is significantly impacting practices’ finances two ways in 2015 and beyond. Practices of all sizes can easily file PQRS quality measures to both avoid penalties and qualify for maximum incentive payments. Here’s what you need to know now to protect your reimbursements.

Contents

  • Penalties For Not Filing
  • The Penalties Don’t End There
  • The Good News
  • How to Avoid Penalties and Receive Maximum Incentives

Penalties For Not Filing

Last year over half of all eligible providers didn’t file PQRS data, causing them to lose incentive payments and be hit with a payment penalty in 2016. This year the incentives are gone completely and providers are being heavily penalized for not filing their data.

If a solo practicing eligible provider or medical group doesn’t file 2015 PQRS data, they will be subject to an automatic double whammy in penalties:

  • 2% PQRS penalty, AND
  • 2% Value Based Modifier penalty (solo practitioners and groups of 2-9 Eligible Providers) OR
  • 4% Value Based Modifier penalty (groups of 10 or more EPs)

Based on actual Medicare claims data, Providers who don’t file PQRS for 2015 will face on average an $18,000 penalty in 2017, with the amount being higher for providers who have higher Medicare billings.

The Penalties Don’t End There

The automatic PQRS failure-to-file is steep and will deeply cut into a provider’s bottom line. But what happens if a provider files PQRS using Claims or a Registry? How a practice files its quality data can still negatively impact revenues. Claims and Registry methods will satisfy the PQRS requirement but not the Value Based Modifier program. Therefore, a provider who doesn’t file Value Based Modifier measures, or who scores poorly on those measures, will still be subject up to -4% in penalties under the VBM program. Here’s how it splits out:

  • If you don’t file Value Based Modifier measures, you receive an automatic -2 or -4 % penalty based on the size of your practice.
  • If eligible providers do file VBM measures, but score poorly:
    • Solo practitioners and groups of 2-9 EPs will receive NO negative VBM adjustment. Small practices are protected in 2015 (but won’t be in 2016, so now is the time to look at why your scores are low and correct the issues contributing to them!).
    • Groups of 10 or more EPs will receive a downward adjustment of up to -4%, based on how the providers’ scores match up against all providers who file.

The Good News

Filing PQRS data electronically enables providers to take advantage of a “file once, satisfy two requirements” opportunity. Your electronic PQRS submission also satisfies VBM requirements. Additionally, by using an authorized data submission vendor (DSV), your PQRS submission will also count as your Meaningful Use Quality Measures (or eCQMs, which are part of what’s needed to satisfy Meaningful Use requirements).

How to Avoid Penalties and Receive Maximum Incentives

A full-service DSV extracts quality data directly from any MU2-compliant EHR, aggregates and formats the data, and submits it directly to Medicare with no interaction required by a practice’s administrative or IT staff. The submission also automatically satisfies Value Based Modifier and MU Quality Measures requirements. Using the right DSV avoids failure-to-file penalties, and positions you to receive the maximum VBM incentives possible.

To learn more about PQRS filling click here.