Physician Quality Reporting System (PQRS) in 2013

Introduction

My name is Diane Pedulla and I’m the director of Regulatory Affairs in the Government Relations office of the APA Practice Organization. This video is the third in a series for psychologists on how to participate in Medicare’s Physician Quality Reporting System. The first video, which provides an introduction to and overview of the program, and the second video, which provides specific guidance on how to report in the system, are available at APApracticecentral.org.

Why participate now?

We have been providing information for Medicare participants on the Physician Quality Reporting System – formerly known as the Physician Quality Reporting Initiative since 2009 on Practice Central. But it’s crucial that psychologists begin reporting now to avoid payment penalties in 2015.

For 2013 and 2014, psychologists who successfully participate in PQRS can still earn an additional one-half percent bonus on all of their Medicare charges.

When the switch to a penalty program occurs in 2015, Medicare will need to analyze reporting data from prior years in order to apply payment adjustments. This means the scheduled one and a half percent penalty adjustments for 2015 will be based on 2013 reporting data, and the two percent penalty for 2016 will be based on 2014 reporting data. Psychologists who do not participate in 2013 will automatically receive the one and a half percent penalty adjustment in 2015, and these penalties will apply to all Medicare charges by the provider.

Avoiding the penality vs. Earning the bonus

To help eligible professionals avoid payment penalties, the Centers for Medicare and Medicaid Services has taken steps to facilitate reporting for Medicare providers who are new to PQRS. Psychologists participating in the program for the first time will only need to report one measure for at least one applicable patient in 2013 in order to avoid penalties in 2015.

However, in order to meet the requirements for bonus payments in 2013 and 2014, you must successfully report on at least 50 percent of your applicable Medicare cases.

Successful reporting involves selecting measures that are appropriate for the patient and service provided. For example, if the measure involves adult major depressive disorder, it may not be used for patients under the age of 18.

What’s new for 2013

For 2013, there are now thirteen measures that psychologists are eligible to report. These include the same twelve measures that were available in 2012, along with measure number 325, Adult Major Depressive Disorder: Coordination of Care of Patients with Specific Comorbid Conditions.

Measure 325 indicates the percentage of medical records of patients 18 years and older with a diagnosis of major depressive disorder and a specific diagnosed comorbid condition (such as diabetes, coronary artery disease, chronic kidney disease or congestive heart failure) that are being treated by another clinician with communication to the other clinician treating the comorbid condition.

Unlike in the past, psychologists will have to report for a full calendar year going forward as CMS is no longer offering a 6-month reporting option.

Also beginning in 2013, psychologists will need to use the applicable new CPT codes for psychotherapy along with the appropriate quality code or G-code when billing.

For more information

For more information about participating in PQRS, including a step-by-step guide for new participants, see the Winter 2013 issue of Good Practice magazine, which is available to all Practice Assessment payers. Additional material including questions and answers for psychologists and a complete list of the available measures by year is available in the Quality Improvement Programs section of the Practice Central website.

CMS also provides a list of education materials for health care professionals on its website.

If you have additional questions, contact your local Medicare Administrative Contractor or the  Government Relations office of the APA Practice Organization by phone at (202) 336-5889 or by email.