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PI Integrated PQRS Registry
Powered by Alpha II Dave speaker Presented By: Deidre Lawson Ellis – Product Manager, Practice Insight Stacey LaCotti– Implementation and Training, Alpha II
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AGENDA PQRS – The basics Why PI/Alpha II Registry? Live Demo
Who must participate in PQRS? Reporting requirements Measure requirements Penalties and Audits Why PI/Alpha II Registry? Integrated workflow Automated reporting Live Demo Demo of workflow PQRS Deadlines Next Steps Amendment Enrollment Forms Kickoff call/UI setup Q&A Contact info Dave speaker
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KEY POINTS PQRS – Doesn’t have to be hard Instant Feedback
PI and Alpha II have streamlined this process to be as easy as possible with: Auto Submissions Direct and Easy User Interface Instant Feedback Integrated dashboard Real-time percentages Easy on the wallet, Big on Support Competitive Pricing Three layers of support Submitting through a QUALIFIED Registry Includes ALL measures for Individual and Group reporting! Dave speaker
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PQRS – THE BASICS What is PQRS?
PQRS is part of the initiative to move from the fee for service payment model to pay for performance (P4P). Under the P4P model, payments to a physician are linked with the quality of healthcare provided to the patient. It introduces quality and efficiency incentives and works on the model of coordinated care. The fee for service model, where physicians charge separately for each of the services provided to any patient, has been largely attributed to the increase in medical costs. Having the physicians move away from such a service and linking their payments to provision of quality care will improve the standards of healthcare delivery and serve as a method to reduce costs. Deidre Speaker
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WHO MUST PARTICIPATE Services paid by MPFS and providers who do not participate in an ACO Medicare Physicians Practitioners Therapists Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic Physician Assistant Nurse Practitioner * Clinical Nurse Specialist * Certified Registered Nurse Anesthetist * (and Anesthesiologist Assistant) Certified Nurse Midwife * Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologist Physical Therapist Occupational Therapist Qualified Speech Language Therapist Deidre Speaker *Includes Advanced Practice Registered Nurse
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How can a Registry Participant report?
Individual provider Can report individual measures or measure groups Group Practice Reporting Option (GPRO) Consists of two or more providers Billing assignment is defined by a tax ID Must register through EIDMS (April 1 - June 30, 2016) Reports individual measures Register with EIDMS through the portal at: Deidre Speaker
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Registry 2016 PQRS Reporting Requirements - EPs
Measure Type Reporting Period Criteria Individual measures 12 months Jan 1 - Dec 31, 2016 Data is aggregated by NPI 50% of Medicare FFS patients 9 measures across 3 NQS domains 1 cross cutting measure Measures with a 0% performance rate will not be counted Measure groups Report on at least 1 measure group 20 patients, 11 must be Medicare FFS Deidre Speaker
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Registry 2016 PQRS Reporting Requirements - GPRO
Measure Type Reporting Period Criteria Individual measures 2 – 99 EPs 12 months Jan 1 - Dec 31, 2016 Data is aggregated at the TIN level 50% of Medicare FFS patients 9 measures across 3 NQS domains 1 cross cutting measure Measures with a 0% performance rate will not be counted and CAHPS for PQRS 2- 99 EPs 100+ EPs must report CAHPS for PQRS Must have all CAHPS for PQRS survey measures reported via a CMS certified survey vendor Report on 6 additional measures outside CAHPS for PQRS survey Covering at least 2 NQS domains Deidre Speaker
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The National Quality Strategy (NQS) Domains
MEASURE REQUIREMENTS What is a Measure and How is it Counted? The National Quality Strategy (NQS) Domains In 2016, measures are classified according to the 6 NQS domains that CMS has prioritized Patient Safety Person and Caregiver-Centered Experience and Outcomes Communication and Care Coordination Effective Clinical Care Community/ Population Health Efficiency and Cost Reduction Deidre Speaker
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MEASURE REQUIREMENTS Denominator Numerator
PQRS Measure Denominators and Numerators Measures consist of two major components: denominators and numerators Denominator Qualifies patient for the measure Includes reporting frequency requirements (if applicable) Can include patient demographic information Can contain diagnosis and CPT/HCPCS code requirements Numerator Deidre Speaker Contains the clinical guidelines for when to use each Quality Data Code (QDC) associated with the measure Indicates whether measure will be met, not met, or considered a performance exclusion based on the QDC submitted
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MEASURE REQUIREMENTS Deidre Speaker
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MEASURE REQUIREMENTS Deidre Speaker
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MEASURE REQUIREMENTS Deidre Speaker
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MEASURE REQUIREMENTS How is a PQRS Measure Calculated? Calculating the PQRS reporting rate (dividing the reported numerator outcomes by the denominator-eligible encounters) identifies the percentage of a patient population reported For performance rate calculations, some patients may be subtracted from the denominator based on medical, patient, or system performance exclusions allowed by the measure The final performance rate calculation represents the eligible population that received a particular process of care or achieved a particular outcome Deidre Speaker
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MEASURE REQUIREMENTS The CMS web page
2016 PQRS Individual Claims Registry Measure Specifications 2016 PQRS Measures Groups Specifications Supporting Documents 2016 Cross Cutting Measures 2016 Specialty Measure Sets The web search tool (new for 2016) Can lookup measures by measure number, reporting method, NQS domain, measure steward, and cross cutting measures View in web tool or download and save measure specifications Finding Measure Specifications Deidre Speaker
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PENALTIES AND AUDITS MAV
What happens if the minimum requirements are not met? Measure Applicability Validation (MAV) MAV Inability to report 9 measures or 3 NQS domains or 1 cross cutting measure Different process for claims-based and registry reporting methods Applies to specialties with limited applicable measures Reviews reported measures linked to measure clusters Deidre Speaker
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WHY ALPHAII and PI? Report on ALL quality metrics
All individual measures All group measures ALL specialty types and group sizes Eligible professionals (EPs) Group practices (GPROs) FULLY INTEGRATED No disruption to user workflow Submitted when the claims are uploaded to EDI Eliminates need for manual entry Tasking identifies measures in error without stopping adjudication and reimbursement Automatic submission to CMS CMS sends confirmation to Alpha II Alpha II forwards to EDI Sophisticated analytics feedback Ensures outcomes and attestations are met Up-to-date metrics show percentage of reported measures in compliance Deidre Speaker
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LIVE DEMO - PI Deidre Speaker
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LIVE DEMO – Alpha II Deidre Speaker
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PQRS DEADLINES PQRS 2016 Timeline January 1st 2016
Reporting for the 2016 PQRS program year begins for both group practices and individuals (Note: 2016 program year data will determine the 2018 payment adjustment). June 30th 2016 This is the last day that providers can sign up to submit as a GPRO with CMS. If this is not done prior to this date, all providers must report as an Eligible Professional (EP) with their individual NPI. February 15th Submitter Registration and Entity Setup Deadline: All registrations must be submitted to Alpha II, LLC registration and Submitters must have entities created and measures selected by midnight on this date. March 1st Final Report Data Load Deadline: All Submitter reporting data must be submitted to Alpha II, LLC by midnight on this date. This means that all data must be submitted in an approved format and the Reseller’s Submitters must review and finalize their data through the Alpha II Registry portal by midnight on this date. No data will be accepted after this deadline. March 3rd 2017 Final Approval Attestation Deadline: The Reseller’s Submitters must complete the final approval attestation of data by midnight of this date. There is a four-hour waiting period between the Finalize Report Data Load and the availability of the Final Approval Attestation. Deidre Speaker
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TAKE-AWAYS Easy to use CMS QUALIFIED Registry Instant Feedback
PI and Alpha II have streamlined this process to be as easy as possible with: Auto Submissions Direct and Easy User Interface CMS QUALIFIED Registry Includes ALL measures for Individual and Group reporting! Instant Feedback Integrated dashboard Real-time percentages Easy on the wallet, Big on Support Competitive Pricing Three layers of support Deidre Speaker
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NEXT STEPS Contact Your Reseller
Obtain and sign Provider End User Agreement to enroll Kick Off Call Review Customer and Task Setup Review settings in the PQRS UI Pick measures Submit past claims Train on continuing claim submission Deidre Speaker
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QUESTION AND ANSWER Everyone
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