2014 PQRS Rule Changes

Ask Joy: This Week – 2014 PQRS Rule Changes

Seems like we were just wrapping our heads around the 2013 PQRS reporting requirements, but it’s already time to start preparing for next year. So, let’s take a closer look at the major changes to be mindful of.

What are the 2014 PQRS rule changes? 

CMS issued the final rule on November 27, 2013, that updates the quality reporting initiatives for next year and includes the implementation of the Value-Based Payment Modifier that will affect the payment rates to certain groups with 10 or more providers, based on the quality and cost of care they furnish to Medicare beneficiaries.

The major changes for the 2014 PQRS program include:

  • Total of 284 measures in 2014 (up from 259 in 2013)
  • 9 individual measures to be reported via claims and registry (up from 3)
  • Threshold change for both individual EPs and groups reporting individual measures via registry to 50% of the eligible professional’s (EP’s) applicable patients (down from 80%)
  • Option to report on claims-based measures groups eliminated

Furthermore, the rule established the following:

  • EPs and group practices that meet the criteria for 2014 PQRS incentive will automatically avoid negative payment adjustment in 2016
  • EPs using the claims and registry-based reporting mechanisms as well as the newly implemented qualified clinical data registry reporting mechanism may report 3 measures on 50% of their applicable patients to avoid 2016 PQRS payment adjustments
  • The option to report on claims-based measures groups to avoid future payment adjustments has been eliminated

For groups who elect to participate using the Group Practice Reporting Option (GPRO) in 2014, the rule included:

  • Creation of a new reporting mechanism, the certified survey vendor reporting mechanism, that allows a group of 25 or more EPs to count reporting of Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CG CAHPS) survey measures towards meeting criteria for satisfactory reporting for the 2014 PQRS incentive and 2016 PQRS payment adjustment

For more information about participating in PQRS in 2014, visit the CMS PQRS website. The full text of the final rule is available online for your reading pleasure.

About the Author: Joy Rios has worked directly with multiple EHRs to develop training programs for both trainers and practice staff. She has successfully attested to Meaningful Use for multiple ambulatory practices in both Medicare and Medicaid. She also authored the Certified Professional Meaningful Use course for www.4Medapproved.com. Joy holds an MBA with a focus in sustainability. She is Health IT certified with a specialty in Workflow Redesign, holds HIPAA security certification, and is a great resource for information regarding government incentive programs.Ask Joy is a regular column on 4Medapproved HIT Answers.