If a provider did not report to PQRS in 2013 and is being assessed a -1.5% payment reduction, then he or she cannot report 2013 data retroactively. Eligible professionals, which include both dermatologists and non-physician clinicians who bill Medicare, should make every effort to report in 2014 to try to avoid a payment reduction in 2016.
A review of the steps dermatologists should take to begin reporting to Medicare's Physician Quality Reporting System in order to avoid negative payment adjustments for non-reporting.
2013 payment reduction appeals
If one believes that he or she received an incorrect Physician Quality Reporting System (PQRS) payment reduction letter from the Centers for Medicare and Medicaid Services (CMS), this information can be verified without calling the CMS Help Desk by utilizing CMS' new PQRS Look Up tool. The PQRS Look Up tool is connected to the same files the CMS Help Desk accesses to verify whether a provider is subject to the 2015 PQRS payment adjustment or should have received a 2013 PQRS incentive. To utilize the tool, providers and practices will need to type in their Tax Identification Number (TIN) or TIN/ National Provider Identifier (NPI) combo.
If one feels he or she is receiving a PQRS payment adjustment in error, an Informal Appeal will need to be filed by February 28, 2015. This can be done through the Communication Support Page.
An informal review may be requested for any of the following reasons:
- A practice's PQRS feedback report indicates that the provider or group practice did not earn the PQRS incentive payment when they believe they should have;
- A practice believes the PQRS payment amount was incorrect; or
- A practice received a notification in error from CMS indicating the provider or group practice did not successfully participate in 2013 PQRS and will receive a 2015 PQRS payment adjustment.
2015 physician quality reporting
In 2015, eligible professionals (EPs) must report at least nine quality measures that cover at least three of the National Quality Strategy Domains. An EP is any provider who bills Medicare under his or her own NPI. If an EP works under multiple tax ID numbers (TINs), he or she must report PQRS under each one.
CMS also detailed a new requirement stating that at least one of the reported measures must be from a set of cross-cutting measures. Each measure must be reported for at least 50 percent of the EP’s Medicare Part B fee-for-service patients seen Jan. 1 through Dec. 31, 2015 for which the measure applies. The five dermatology-specific measures, #137, #138, #224, #265, and #337, from the 2014 program will continue. Additionally, there will be a new pathology measure that applies to melanoma: measure #397. This measure looks at whether the EP has documented pathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness and ulceration and for pT1, mitotic rate.
If less than nine measures apply, EPs must go through the Measure Applicability Validation (MAV) process. CMS uses this process to evaluate whether or not EPs could have reported on additional measures, and determine whether or not they satisfied reporting requirements.
- See registry MAV requirements here
- View the CMS MAV Training Course here
The forthcoming 2015 QRS registry will be able to report 18 measures.
- Download a list of these measures here
- View the final specifications for these measures here
Browse the tools and resources below to get started.