You may have received a letter from CMS that you are subject to a payment adjustment/ reduction of 1.5% in 2015 due to insufficient PQRS reporting in 2013. There are a number of different reasons that your reporting may have been insufficient.
You may not have reported at least one measure on 50% of your Medicare patient’s to meet the requirement and avoid the reduction. This may be through a failure to document for claims based reporting. Also, our billing company colleagues report that some billing software will accept the codes on the physician portion of a medically directed claim but need manual input of the measures on the CRNA portion. If this is not addressed the CRNA measures will not be reported.
The 2015 reporting increases the requirement to 9 measures including 2 outcomes measures. For more information visit the CMS website at PQRS.
Now is the time to review and re-evaluate your practices to assure that you will not suffer a further reduction in 2017 based on 2015 reporting. Auditing is an important part of a compliance program and can help you find and correct problems that present legal liability or financial consequences.