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ABC's of Quality Reporting: Your 2016 Roadmap for PQRS, Value-based Modifier, and the Merit-based Incentive Payment System

ABC's of Quality Reporting: Your 2016 Roadmap for PQRS, Value-based Modifier, and the Merit-based Incentive Payment System


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Joy Rios, MBA, CHTS-PW

Healthcare professionals across the country are tasked with collecting more and more data to essentially prove to the government how well doctors do their jobs. Several complex quality programs must now be reported on annually or providers will pay a hefty price.

ABC's of PQRS gives you a full spectrum of content:

  • Examining how several health IT programs are interconnected, including PQRS, Value based Modifier and the Merit-based Incentive Payment System
  • Providing explicit examples of penalty scenarios based on the size of a doctor’s practice
  • Addressing the various ways to report quality to the government

If you are unclear about the program requirements, confused about how to start, are having difficulty knowing which measures to report, or you don’t understand how PQRS reporting will affect your future reimbursements, this book is for you.

EARLY PRAISE

"This brave new world of Pay-for-Performance & Value-Based Medicine that affects all physicians is one of the largest revenue opportunities in decades. This book is an exceptional resource!"

TABLE OF CONTENTS

Chapter 1: Understanding Quality Reporting Context
  • The Path for 2016
  • Looking Back
  • The Road Ahead
  • Financial Impacts of CMS Quality Programs
  • PQRS Basics
  • Avoiding Payment Adjustments
  • Eligibility Requirements
  • Eligible but Not Able to Participate
  • Scenario 1: Does not bill services payable under the MPFS
  • Scenario 2: Does not submit individual rendering National Provider Identifier (NPI)
  • Naming Conventions
  • Reporting Periods
  • Individual versus Group Reporting
  • Group Practices Defined
  • Why Choose One or the Other
  • PQRS Measures
  • Where Measures Come From
  • Defining Quality Measures
  • Calculating Quality Measures
  • Determining a Quality Measure’s Reporting Frequency
  • Performance Timeframes
  • Types of Measures
  • Availability of Measures
  • Measure Selection Strategy
  • Individual Measures
  • Measures Groups
  • Specialty Measure Sets
  • Cross-Cutting Measures
  • PQRS Reporting for Pathologists
Chapter 2: PQRS Reporting Methods
  • Claims (I)
  • Registry (I) (G)
  • Electronic Health Record (EHR) (I) (G)
  • EHR-Direct versus DSV
  • Qualified Clinical Data Registry (I)
  • Group Practice Reporting Option (GPRO) Web Interface (G)
  • Web Interface Quality Measures
  • Certified Survey Vendors (CAHPS for PQRS) (G)
Chapter 3: Understanding the Value-based Payment Modifier (VM)Program
  • Calculating a VM Score
  • Quality Composite
  • Cost Composite
  • Risk Factors of a Practices Attributed Beneficiaries 
  • How Does CMS Determine National Benchmarks?
  • Quality Tiering
  • Quality Resource and Use Reports (QRURs)
  • Performance Highlights Page of the QRUR
  • Informal Review
  • How to Request an Informal Review
  • Informal Review Decision
Chapter 4: Public Reporting of Quality
  • Physician Compare
Chapter 5: Physician Quality Reporting System (PQRS) Best Practices
  • Getting Help
  • Frequently Asked Questions (FAQs)
  • Acronymns.
Appendix
  • Claims-based Reporting Coding
  • Measure Applicability Validation
  • Clinical Relation Test
  • Minimum Threshold Test
Joy Rios

Joy Rios, MBA,CHTS-PW, is a health IT expert, author, and nationally known speaker on the topics of the EHR incentive (Meaningful Use), PQRS, and value-based payment programs. Rios contributes articles to health IT publications and is the author of “ABCs of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System.” In 2015, Rios joined Miraca as a Technical Director. In addition to holding a BA and MBA, she also is a Certified Healthcare Technology Specialist with a focus on practice workflow.