2015 PQRS EHR Reporting

Tammy McNeil, RHIA, CPHIT, CPEHR

Jane Stotts, RN, BSN

Quality Improvement Advisors

Disclaimer

This webinar applies only to EHR-based reporting for PQRS. It does not provide guidance for other Medicare or Medicaid incentive programs, such as the Electronic Health Record (EHR) Incentive Program, or the Value-based Modifier.

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Purpose of Webinar

How to report PQRS using CEHRT for the 2015 reporting period for:

• Individual EPs

• Group practices that have registered to report as a GPRO

Although we briefly mention the requirements for avoiding the 2017 PQRS payment adjustment, complete information is available on the CMS PQRS website.

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Note for Medicare EHR Incentive Program Participants

If an EP satisfactorily reports for 2015 PQRS using the EHR reporting option, (s)he will also satisfy the CQM component of the EHR Incentive program; however, EPs will still be required to meet the other Meaningful Use Core and Menu Set objectives through the Medicare EHR Incentive Program Registration and Attestation System.

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Step 1: Determine if you are eligible to participate in PQRS

• A list of Eligible Professionals who are eligible to participate in PQRS is available on the CMS website – Read this list carefully, as not all providers are

considered Eligible Providers

• IMPORTANT: The PQRS definition of an EP differs from the Medicare EHR Incentive Program’s definition. Find information on who is eligible to participate within the Medicare EHR Incentive Program.

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Who is Eligible to Participate in PQRS?

• Under Physician Quality Reporting System (PQRS), covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS).

• Note: Beginning in 2014, professionals who reassign benefits to a Critical Access Hospital (CAH) that bills professional services at a facility level, such as CAH Method II billing, can now participate. To do so, the CAH must include the individual provider NPI on their Institutional (FI) claims.

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Step 2: Verify you have an ONC-Certified EHR Technology Product (CEHRT)

• The Office of the National Coordinator (ONC) for Health Information Technology certification process has established standards and other criteria for structured data that EHRs must use.

• For more information to determine if your product is CEHRT, please visit the EHR Incentive Program Certified EHR Technology website (CHPL) or check with your EHR vendor.

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CEHRT: EHR Direct or EHR DSV

• Direct EHR vendors are those vendors who are certifying an EHR product and version for EPs or group practices to utilize to directly submit their measure data to CMS in the CMS-specified format(s) on their own behalf.

• An EHR Data Submission Vendor (DSV) is an entity that collects an individual EPs or group practices clinical quality data directly from the EP’s or group practice’s EHR. DSVs will be responsible for submitting measure data from an EP or group practice’s certified EHR to CMS via a CMS-specified format on behalf of the EP or the group practice for the program year.

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Step 3: Determine which measures apply to your practice

• Report 9 measures covering at least 3 of the NQS domains

• If the EHR product does not contain patient data for at least 9 measures covering at least 3 domains, then report all of the measures for which there is Medicare patient data

• An EP or GPRO would be required to report on at least 1 measure for which there is Medicare patient data

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Measure Counts

Reporting Method 2014 2015

EHR 64 62

Qualified Registry 201 173

Claims 110 70

GPRO Web Interface 22 19

Measures Groups 25 22

Totals

Measures 284 255

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Review Measures List

• Review the list of measures on the 2015 PQRS Measures List – Remember to check with your EHR vendor, as they will have built

specific measures for your system to report

– See the Resources page for link to the Measures List

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Step 4: Register or verify your EIDM account

• If you are submitting quality measure data directly from your EHR system, you must have an EIDM account

• More information about how EPs can get an EIDM account is posted on the main page of the Physician and Other Health Care Professionals Quality Reporting Portal (Portal)

• If you need assistance please contact the QualityNet Help Desk at 866-288-8912

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Step 5: Create required reporting files

• Work with your EHR vendor to create the required files from your EHR for upload through QualityNet

• Many EHR vendors have created PQRS reports as standard reports

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Step 6: Participate in validation testing to ensure submission

• CMS strongly recommends that EPs participate in the validation testing for data submission or ensure that their DSV participates prior to submission to ensure that data errors do not occur

• Speak with your EHR vendor to discuss any data submission issues

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Step 7: Submit files

• Submit final EHR submission files with quality measure data or ensure that your DSV has submitted your files by the data submission deadline of February 29, 2016 to be analyzed and used for 2015 PQRS measure calculations

• Following each successful file upload, notification will be sent to the EIDM users email address indicating that the files were submitted and received

• Submission reports will then be available to indicate file errors, if applicable

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Resources

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CMS PQRS website http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRI

Physician and Other Health Care Professionals Quality Reporting Portal (Portal) https://www.qualitynet.org/portal/server.pt/community/pqri_home/212 Eligible professionals is available on the How to Get Started page of the CMS PQRS website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRSList_of_Eligible_Professionals.pdf

PQRS Implementation Guide: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_ImplementationGuide.pdf

2015 PQRS Measures List http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html

Medicare EHR Incentive Program http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/

Quality Net Help Desk Support http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/HelpDeskSupport.html Or Phone: 1-866-288-8912, Email: Qnetsupport@hcqis.org

Contact Information by State

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Kansas

Sarah Good Sarah.good@area-

A.hcqis.org

Kaitlin Nolte Kaitlin.nolte@area-

A.hcqis.org

P: 785.273.2552 F: 785.273.5130

Nebraska

Tammy McNeil tammy.mcneil@area-

A.hcqis.org

Jane Stotts jane.stotts@area-

A.hcqis.org

Tammy: 402.476.1399 x504 Jane: 402.476.1399 x507

F: 402.476.1335

North Dakota

Tracey Regimbal Tracey.regimbal@area-

A.hcqis.org

Patti Kritzberger Patti.kritzberger@area-

A.hcqis.org

Tracey: 701.721.9737 Patti: 701-870-1600

F: 701.857.5755

South Dakota

Nancy McDonald Nancy.mcdonald@area-

A.hcqis.org

P: 605.234.4144 F: 605.373.0580

This material was prepared the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-NE-D1-21/0915