2014 updates to Medicare’s Physician Quality Reporting System
Psychologists who participate in Medicare can still receive a 0.5 percent bonus payment for all Medicare payments by participating in the Physician Quality Reporting System (PQRS) in 2014. However, 2014 marks the final year of bonus payments under the program.
Starting in 2015, the Centers for Medicare and Medicaid Services (CMS) will begin imposing penalties for eligible providers who did not successfully participate in 2013. Those who were participating in PQRS for the first time in 2013 only need to report one measure for one patient in order to avoid the 2015 penalty. Practitioners still have until Feb. 28, 2014, to submit a claim with a reported measure for a service that was provided during the calendar year from Jan. 1-Dec. 31, 2013.
Successful participation in 2014 is necessary to avoid the penalty in 2016. The penalties will be 1.5 percent in 2015 and 2 percent in 2016.
Eligible professionals are expected to report on nine PQRS measures across three domains in 2014 in order to qualify for the 0.5 percent bonus. The domains reflect six different priorities for health care quality improvement and can be found on the CMS 2014 list of PQRS measures (PDF, 696KB). Those for whom fewer than nine measures apply could still qualify for the bonus. If a psychologist reports on one to eight measures their claims will be reviewed so that CMS can determine if additional measures should have been reported.
Further guidance on Pratice Central
The APA Practice Organization (APAPO) has updated the Quality Improvement Programs section of its Practice Central website with the latest information for 2014 for both new participants and those who are already reporting in the program. Resources include a list of measures available for 2014, a quick reference guide that links applicable codes to each measure, frequently asked questions and video tutorials on participating in PQRS.
PQRS was not drastically altered for psychologists under the 2014 Medicare final fee schedule rule. However, the following changes are important to note:
- The 2 percent annual cut to Medicare payments under sequestration will also apply to PQRS bonuses in 2014. If a provider earns a $500 bonus under PQRS, the bonus payment will be reduced to $490.
- Two of the individual measures that psychologists are eligible to use will no longer be available for claims-based reporting in 2014. Measures No. 9 (Major Depressive Disorder: antidepressant medication during acute phase) and No. 173 (Unhealthy alcohol use) must now be reported through a registry.
- For 2014, all measures groups, including the one for dementia, may only be reported via a registry. Eligible professionals will no longer be able to report a measures group through claims-based reporting.
Psychologists who do not find any of the measures to be applicable to their services and/or patient population should contact the CMS QualityNet Help Desk for assistance. The QualityNet Help Desk is available Monday through Friday, 7 a.m.-7 p.m. CST, or by telephone at (866) 288-8912 [TTY (877) 715-6222]. Inquiries may be sent by email.