Transcript Adult Kidney Disease: Blood Pressure Management

PQRS 2014
How to use Falcon Physician to meet the measures | August 2014
What is PQRS?
Physician Quality Reporting System
A reporting program, mandated by federal
legislation, that uses a combination of incentive
payments and payment adjustments to promote
reporting of quality information by eligible
professionals.
Who Needs to Report
Do I need to report PQRS for 2014?
Yes – all physicians/ eligible providers need to report PQRS in 2014 to
avoid a penalty in 2016 and beyond.
***If you report and do not qualify for an incentive – reporting three
measure will prevent incurring a penalty.
***Falcon will report for ALL physicians to ensure they will not incur a
penalty. (Based on the return of the PQRS consent form which will be
distributed in late 2014).
Eligible providers report separately….individually through the registry
method. Just as they do for Meaningful Use.
Incentive or Penalty
What do I Get?
Incentive $ = 0.5% of Medicare
allowed charges.
What If I Do Not Report for 2014?
Penalty for 2016: Is a payment adjustment = 2%
The Measures
What are the PQRS Measures?
Falcon has chosen a small number of measures that are applicable
to Nephrologists AND made it easy for you to report directly on the
Superbill under the Quality Measures button.
Falcon Physician is a certified Registry for reporting PQRS so we will
be pulling the data from Falcon at the end of the year and reporting
the measures through our registry for each provider that consents
to the submission of their data and qualifies.
Reporting Individual Measures
At the end of the year, report either:
Minimum of 9 of the Individual measures for 1 Yr (1/1/14-12/31/14)
Minimum to report = 50% of Medicare Part B patients (primary or secondary)
Earn Incentive $ = .5% of 1 yr of Medicare FFS
Individual Measures (Report 9):
#1 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus (Checkbox on Superbill)
#2 Diabetes Mellitus: LDL-C Control in Diabetes Mellitus (CQM NQF #64) (Checkbox on Superbill)
#110 Preventive Care and Screening: Influenza Immunization (Checkbox on Superbill)
#111 Pneumonia vaccine 65+ (Checkbox on Superbill)
#121 Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Checkbox on Superbill)
#122 Adult Kidney Disease: Blood Pressure Management (CQM NQF #61) (Checkbox on Superbill)
#123 Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Checkbox on Superbill)
#128 Preventive Care and Screening: BMI Screening and Follow-up (CQM NQF #421) (Checkbox
on Superbill)
#130 Documentation of Meds (NQF#0419) (Checkbox on Superbill)
#226 Preventive Care and Screening: Tobacco Use: Screening & Cessation Intervention (CQM NQF
#28)
#236 Hypertension: BP Management (NQF#18) (Checkbox on Superbill)
#317 High BP Screening (NQF#TBD) (Checkbox on Superbill)
Reporting Group Measures
All of the CKD Group Measures for 1 Yr or 6 months
Minimum to report = 20 unique patients (primary or secondary)
Earn Incentive $ = .5% of 1 yr or 6 months of Medicare FFS
Measures we selected do not include Dialysis E & M codes so Dialysis patients seen IN CENTER are not included for PQRS
Measures in Falcon.
Participating eligible professional must report on all applicable measures within the selected measures group for a minimum
sample of 20 unique patients, a majority (11) of which must be Medicare Part B FFS patients, who meet patient sample criteria for
the measures group. If the eligible professional does not have at least 20 unique patients who meet patient sample criteria for the
measures group, the eligible professional will need to choose another reporting option.
All applicable measures within the group must be reported at least once for each patient within the sample population seen by the
eligible professional during the reporting period (January 1 through December 31, 2014 OR July 1 through December 31, 2014) for
each of the 20 unique patients
.
#110
#121
#122
#123
Preventive Care and Screening: Influenza Immunization (Checkbox on Superbill)
Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Checkbox on Superbill)
Adult Kidney Disease: Blood Pressure Management (CQM NQF #61) (Checkbox on Superbill)
Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Checkbox on Superbill)
Individual Measures
Individual Measures
Report on 9 of these measures (1 year reporting period):
#1 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus
#2 Diabetes Mellitus: LDL-C Control in Diabetes Mellitus
#110 Preventive Care and Screening: Influenza Immunization (Group Measure )
#111 Pneumonia vaccine 65+
#121 Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Group Measure )
#122 Adult Kidney Disease: Blood Pressure Management (Group Measure )
#123 Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Group
Measure )
#128 Preventive Care and Screening: BMI Screening and Follow-up
#130 Documentation of Meds
#226 Preventive Care and Screening: Tobacco Use: Screening and Cessation
Intervention
#236 Hypertension: BP Management
#317 High BP Screening
Individual Measures – how many?
50% of Medicare Part B patients need to be reported
for each measure.
You can check the denominators and numerators for each measure in
your Quality Scorecard.
To meet the incentive you will need to meet 9 individual measures
across 3 domains.
In order to avoid the penalty you will need to submit on 3 valid
measures displaying at least one Medicare Part B patient.
Use the Medicare Part B report in Falcon to ensure you have least one
Medicare B patient in a Measure.
Individual Measures – on the Superbill
Measures in Review - #1 (Individual)
#1 (NQF 0059): Diabetes Mellitus: Hemoglobin A1c Poor Control
Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c
greater than 9.0% (reverse measures – so less performance (less in numerator) is better)
Denominator = Seen in the reporting period AND age 18 to 75 yrs AND
One of the Diabetes Mellitus ICD code entered in Problem List:
250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51,
250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81,
250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05,
362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04
Numerator = Most recent Hgb A1c >9.0% Quality Measures button in the Superbill- Check box for #1 - OR
Lab Result for Hemoglobin A1c entered in Falcon (Interfaced or Manually entered)
OR
Use 3045F: Most Recent hemoglobin A1c level between 7 and 9
Use 3046F: to indicate the most recent hemoglobin A1c level > 9.0%
Measures in Review - #2 (Individual)
#2 (NQF 0064): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control
Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent LDLC level in control (less than 100 mg/dL)
Denominator = Seen in the reporting period AND age 18 to 75 yrs AND
One of the Diabetes Mellitus ICD code entered in Problem List:
250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50,
250.51,
250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80,
250.81,
250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04,
362.05,
362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04
Numerator = LDL-C < 100 mg/dl - Quality Measures button in the Superbill- Check box
for #2
OR
Lab Result for LDL-C entered in Falcon (Interface or Manually entered)
OR Use 3048F: to indicate Most recent LDL-C < 100 mg/dL
Measures in Review - #110 (Individual)
#110 (NQF 0041): Preventive Care and Screening: Influenza Immunization
Percentage of patients aged 6 months and older seen for a visit between October 1 and
March 31 who received an influenza immunization OR who reported previous receipt of
an influenza immunization
Measure #110 only needs to be reported a minimum of once during the reporting period when
the patient’s visit included in the patient sample population is between January and March for
the 2013-2014 influenza season OR between October and December for the 2014-2015
influenza season. When the patient’s office visit is between April and September,
Measure #110 is not applicable and will not affect the eligible provider’s reporting or
performance rate.
Denominator = Patients > 6 mos. old AND Office Visit with valid E & M Code AND Visit
is between Jan – Mar 2014 OR Oct – Dec 2014.
Numerator = Quality Measures button in the Superbill- Check box for #110
OR
Use CPT code G8482: Influenza immunization administered or previously
received
Measures in Review - #111 (Individual)
#111 (NQF 0043): Pneumonia Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Denominator = Seen in the reporting period AND are age > 65 yrs.
Numerator = Patients who have ever received a pneumococcal vaccination
Quality Measures button on the superbill - Check the box in the superbill - Check box for #111
OR
Use CPT II 4040F: Pneumococcal vaccine administered or previously received in the procedures
section of your encounter.
OR
Pneumococcal Vaccination not Administered or Previously Received, Reason not Otherwise
Specified Use CPTII 4040F with Modifier 8P in the procedures section of your encounter.
Measures in Review - #121 (Individual)
#121:
Adult Kidney Disease: Laboratory Testing (Lipid Profile
Percentage of patients aged 18 years and older with a diagnosis of CKD (stage
3, 4 or 5, not receiving Renal Replacement Therapy [RRT]) who had a fasting
lipid profile performed at least once within a 12-month period
Denominator = Patient with CKD 3, 4 or 5 diagnosis code AND Patients > 18
yrs. old AND Office Visit w/ valid E & M Code
Numerator = Quality Measures button in the Superbill- Check box for #121
OR
Lab Test Results for Lipid Profile (Interface or Manually entered)
OR
Use CPT code G8725: Fasting lipid profile performed
(Triglycerides, LDL-C, HDL-C, and Total Cholesterol)
Measures in Review - #122 (Individual)
#122: Adult Kidney Disease: Blood Pressure Management
Percentage of patient visits for those patients aged 18 years and older with a diagnosis of CKD (stage 3, 4
or 5, not receiving Renal Replacement Therapy [RRT]) and documented proteinuria with a blood pressure
< 130/80 mmHg OR ≥ 130/80 mmHg with a documented plan of care
Plan of Care - A documented plan of care should include one or more of the following: recheck
blood pressure within 90 days; initiate or alter pharmacologic therapy for blood pressure control;
initiate or alter non-pharmacologic therapy (lifestyle changes) for blood pressure control; documented
review of patient’s home blood pressure log which indicates that patient’s blood pressure is or is not
well controlled
Denominator = Patient with CKD 3, 4 or 5 diagnosis code AND Patients > 18 yrs. old AND Office
Visit with valid E & M Code AND Proteinuria (791.0) in the patient Problem
List.
Numerator = Enter Vitals into Vitals section OR Quality Measures button in the Superbill- Check
box for #122 (checking the box indicates you documented a Plan of Care if required)
OR
Use G8476: to indicate the most recent blood pressure has a systolic measurement of < 130
mmHg and a diastolic measurement of < 80 mmHg
G8477: Most recent blood pressure has a systolic measurement of ≥ 130 mmHg and/or a diastolic
measurement of ≥ 80 mmHg
AND
Use CPT 0513F: to indicate elevated BP plan of care documented
Measures in Review - #123 (Individual)
#123: Adult Kidney Disease: Patients On Erythropoiesis-Stimulating Agent (ESA) Hemoglobin Level > 12.0 g/dL
Percentage of calendar months within a 12-month period during which a hemoglobin level is
measured for patients aged 18 years and older with a diagnosis of advanced CKD (stage 4 or
5, not receiving RRT [Renal Replacement Therapy]) or End Stage Renal Disease (ESRD)
(who are on hemodialysis or peritoneal dialysis) who are also receiving ESA therapy AND
have a hemoglobin level > 12.0 g/dL
Denominator = Patient with CKD 4 or 5 diagnosis code AND Patients > 18 yrs. old AND
Office Visit with valid E & M Code AND are receiving ESA from you
or any provider
Numerator = Quality Measures button in the Superbill- Check box for #123
OR
Lab Result for Hemoglobin entered in Falcon (Interface or Manually entered) > 12
OR G0908: Most Recent Hemoglobin (Hgb) level > 12.0 g/dL
AND
Use CPT 4171F: Patient receiving erythropoiesis-stimulating agents (ESA) therapy
Measures in Review - #128 (Individual)
#128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and
Follow-Up
Percentage of patients aged 18 years and older with a calculated BMI in the past six months or
during the current visit documented in the medical record AND if the most recent BMI is
outside of normal parameters, a follow-up plan is documented within the past six months or
during the current visit
BMI Parameters:
Age 65 years and older BMI ≥ 23 and < 30
Age 18 – 64 years BMI ≥ 18.5 and < 25
Denominator = patients > 18 Yrs old AND Office Visit with valid E & M Code
Numerator = BMI calculated in range OR if BMI is out of range (document Plan of Care
as required) – Quality Measures button in the Superbill- Check box for #128 OR if
patient has V65.3 (Dietary Surveillance and counseling) in their problem list OR
G8417: Calculated BMI above normal parameters and a follow-up plan was
documented OR
G8418: Calculated BMI below normal parameters and a follow-up plan was
documented
Current Medication Documented in Medical
Record - #130 (Individual)
Measure #130 (NQF 0419):Documentation of Current Medications in the Medical Record
DESCRIPTION:
Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list
of current medications using all immediate resources available on the date of the encounter. This list must
include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional)
supplements AND must contain the medications’ name, dosage, frequency and route of administration.
DENOMINATOR:
All visits for patients aged 18 years and older who had a visit during the reporting period
AND
NUMERATOR:
Eligible professional attests to documenting, updating or reviewing a patient’s current medications using all immediate
resources available on the date of encounter. This list must include ALL prescriptions, over-the counters,
herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name,
dosages, frequency and route of administration.
Select the quality measures button in the superbill – Measures #130
OR
Select the 3rd check box in the Medications/Allergies section in your encounter.
OR
G8427: Current medications documented
Measures in Review - #226 (Individual)
#226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and
Percentage of patients aged 18 years and older who were screened for tobacco use one or
more times within 24 months AND who received cessation counseling intervention if identified
as a tobacco user
Cessation Counseling Intervention – Includes brief counseling (3 minutes or less), and/or
pharmacotherapy
Denominator = Patients > 18 Yrs old AND Office Visit with valid E & M Code
Numerator = Enter ANY Smoking Status history in the encounter AND
Checkbox in Assessment & Plan section of the encounter to indicate
smoking cessation was discussed
OR screened for tobacco use AND received tobacco cessation intervention
(counseling, pharmacotherapy, or both), if identified as a tobacco user 4004F: Patient
screened for tobacco use AND received tobacco cessation intervention, if
identified as a tobacco user
OR Patient Screened for Tobacco Use and Identified as a Non-User of
Tobacco 1036F: Current tobacco non-user
OR Select the checkbox under Quality Measures in the Superbill select – Checkbox # 226
Measures in Review – 226 (Individual)
Measure #236 (NQF 0018): Controlling High Blood
Pressure
Measure #236 (NQF 0018): Controlling High Blood Pressure
DESCRIPTION:
Percentage of patients 18 through 85 years of age who had a diagnosis of hypertension and whose
blood pressure was adequately controlled (< 140/90 mmHg) during the measurement period
DENOMINATOR:
Patients 18 through 85 years of age who had a diagnosis of essential hypertension 401.0, 401.1, 401.9
within the first six months of the measurement period or any time prior to the measurement period
NUMERATOR:
Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg
and diastolic blood pressure < 90 mmHg) during the measurement period
**If you enter the BP in the encounter and put the diagnosis code on the problem list, Falcon will
detect this measure automatically.**
OR
Measure #236 (NQF 0018): Controlling High
Blood Pressure Continued
G8752: Most recent systolic blood pressure < 140 mmHg
OR
G8753: Most recent systolic blood pressure
≥ 140 mmHg
AND
G8754: Most recent diastolic blood pressure < 90 mmHg
OR
G8755: Most recent diastolic blood
pressure ≥ 90 mmHg
OR
Patient not Eligible for Recommended Blood Pressure Parameters for Documented Reasons
G9231: Documentation of end stage renal disease (ESRD), dialysis, renal transplant or pregnancy.
OR
Blood Pressure Measurement not Documented, Reason not Given
G8756: No documentation of blood pressure measurement, reason not given
OR Check the box on the Superbill- Checkbox # 236
Measure #317: Preventive Care and Screening: Screening for
High Blood Pressure and Follow-Up Documented
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
DESCRIPTION:
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND
a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated
DENOMINATOR:
Percentage of patients aged 18 years and older who have an encounter in the reporting period.
AND
NUMERATOR:
Patients who had BP recorded in Falcon AND have a recommended follow-up plan documented, as indicated if the blood
pressure is pre-hypertensive or hypertensive
•
Check the box under quality measures in the superbill – Checkbox #317
OR G8783: Normal blood pressure reading documented, follow-up not required
OR G8783: Normal blood pressure reading documented, follow-up not required
OR G8950: Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is
documented
OR G8784: Blood pressure reading not documented, documentation the patient is not eligible
OR G8951: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not
documented, documentation the patient is not eligible OR G8785: Blood pressure reading not documented, reason
not given
OR G8952: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not
documented, reason not given
CKD Group Measures
CKD Group Measures – on the Superbill
Criteria for CKD Group Measures
Whether you are reporting for the 1-year period or the 6-Month period you will
report on a minimum of 20 unique sample patients - of which only 11 have to
Medicare part B. (20 patients in the denominator of each measure will be the same
patients).
All applicable measures within the group must be reported at least once for each
patient within the sample population seen by the eligible professional during the
reporting period (January 1 through December 31, 2014 OR July 1 through December
31, 2014) for each of the 20 unique patients
Denominator for ALL measures = patients with CKD stage 4, or 5 AND
office visit in the reporting period AND > 18 yrs old
CHRONIC KIDNEY DISEASE (CKD) MEASURES GROUP:
#110. Preventive Care and Screening: Influenza Immunization
#121. Adult Kidney Disease: Laboratory Testing (Lipid Profile)
#122. Adult Kidney Disease: Blood Pressure Management
#123. Adult Kidney Disease: Patients On Erythropoiesis-Stimulating Agents (ESA) - Hemoglobin Level > 12.0
g/dL (*)
SummaryWhat to do in Falcon to
meet PQRS
What do I need to do for Falcon
to capture the measures?
• Marking Medicare Part B patients in demographics – THIS IS CRUCIAL.
• Click on checkboxes in SUPERBILL that are applicable to patient
• Pertinent Labs test results can be entered into Falcon as structured data
either through an interface or manually entered into Results Inquiry in order to
meet some of the measures.
• Entering Diabetes ICD code and CKD ICD codes on the problem list (when
applicable)
• Entering vitals – some measures need BP and BMI
•Document Plan of Care when required.
• If not using Superbill, you must put the appropriate CPT codes for the
measures IN THE ENCOUNTER in the procedures section so they are
captured for reporting.
Falcon Superbill
Check ALL that are applicable to visit
Measures – on the Superbill
PQRS check boxes indicated on the Superbill will
not:
•Print on the claim/Superbill
•Flow over to an interfaced billing system on the
claim
•**Procedure codes entered will flow to the
Superbill
Indicate Medicare Part B patients
Indicate which patients are Medicare Part B in Patient Manager >
Demographics with the checkbox
Lab Test Results
LAB TEST RESULTS Entered into Falcon:
Patient Manager > Results Inquiry =
Lab Flowsheet in Encounter =
LAB TEST RESULTS IN ENCOUNTER DO NOT
COUNT
Manual Lab entry into Falcon
Patient Manager > Results Inquiry
Click on
button to manually
add lab test results that did not come
through and interface
Measures that need lab results:
#1 Diabetes : Hgb A1c Poor Control
#2 Diabetes : LDL-C Control
Manual Lab entry into Falcon
Enter lab results for each test into structured fields.
PQRS Measures
Not using the Falcon Superbill?
If you are not finalizing superbills for each office visit, the appropriate procedure
code (CPT) can be entered into the Procedures section of an encounter.
Tracking Your PQRS
Reporting Period Setup
Main Menu->Quality Scorecard->Reporting
Period Setup->Add Reporting Period
How Can I Track my Progress ?
Main Menu->Quality Reporting->Quality Scorecard
There is no performance Goal for PQRS
Use the Medicare Part B report to ensure you have at least one
Medicare Part B patient in any Measure you might report on.
NEED NEW
SCREENSHOT R36
Medicare Part B Report
How do I report PQRS for 2014
Falcon makes it easy!
Falcon is Certified Registry to report PQRS measures to CMS
Falcon lists the measures on the superbill in easy to use checkboxes
Review your Medicare Part B patients by Drilling down on the measure
name on the quality score card
You may run the Medicare Part B report in Falcon under Reports.
Falcon will pull and submit data at the beginning of 2015 via the registry
method
Please return you 2014 PQRS consent forms later this year.
Please look for future communication.
MOCP and Feedback Reports
Maintenance of Certification Program
In 2014, EPs have the opportunity to earn the PQRS incentive and an additional incentive of 0.5% by working with a Maintenance of
Certification entity. Here is what is required:
Satisfactorily submitting data, without regard to method, on quality measures under PQRS, for a 12-month reporting period either as an
individual physician or as a member of a selected group practice
AND
More frequently than is required to qualify for or maintain board certification:
Participate in a Maintenance of Certification Program and
Successfully complete a qualified Maintenance of Certification Program practice assessment.
Feedback Reports
EPs who report PQRS quality measures data can request to receive National Provider Identifier (NPI)-level Physician Quality Reporting
Feedback Reports.
The reports include information on reporting rates, clinical performance, and incentives earned by participating individual professionals,
with summary information on reporting success and incentives earned at the practice level. The feedback reports can be accessed through
the Web portal in the fall of the year following the reporting (e.g. 2013 feedback reports will be available in the fall of 2014).
© 2013 Falcon, LLC. All rights reserved. Proprietary and confidential.
PQRS / NQF / CQM Alignment
PQRS
NQF
Description
Domain
CQM?
1
0059
Diabetes – Hemoglobin A1c Poor control
Clinical Process/Effectiveness
Yes
2
0064
Diabetes – LDL-C Control
Clinical Process/Effectiveness
Yes
110
0041
Flu vaccine
Population/Public Health
No
121
1668
Adult Kidney Disease – Lipid profile
Effective Clinical Care
No
122
N/A
Adult Kidney Disease – BP Management
Effective Clinical Care
No
123
1666
Adult Kidney Disease –Hemoglobin
Effective Clinical Care
No
128
0421
BMI Screening/Followup
Population/Public Health
Yes
226
0028
Tobacco Use Screening/Cessation
Intervention
Population/Public Health
Yes
236
0018
Hyptertension: BP Management
Clinical Process/Effectiveness
Yes
111
0043
Pneumonia vaccine 65+
Clinical Process/Effectiveness
No
130
0419
Documentation of meds
Patient safety
Yes
317
TBD
High BP Screening
Clinical Process/Effectiveness
Yes
CKD Measures Group
16
PQRS Requirements
2013 PY
• Incentive
– Meet 3 individual
measures or the CKD
group
• Avoid penalty
– Submit 1 valid measure
4
2014 PY
• Incentive
– Meet 9 individual measures
(across 3 domains) or the
CKD group
• Avoid penalty
– Submit 3 valid measures
MAV Process- Avoid Payment
Adjustment
• Report 1-2 individual measures across at
least 1 NQS domain via qualified registry
for 50% or more of applicable Medicare
Part B FFS patients and successfully pass
the MAV process
© 2013 Falcon, LLC. All rights reserved. Proprietary and confidential.
Questions?