AccuChecker assurance to PQRS Accuracy


AccuChecker OnLine is not a REGISTRY, our function is a basic business operation, we prepare you to understand PQRS and we guarantee that your submissions to RESGISTRIES are correct, with ZERO rejection and ZERO denial, that at the end of the cycle instead of penalties and reductions in payments, you receive what is proper and what you deserve.


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  •           Over 500 Medicare and Medicaid AUDIT have given us the experience and knowledge to develop our product line.
  •           Our claims scrubber checks out the basic rules in coding including the latest PQRS guidelines.
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The reality about the complexity of PQRS - More practices turn to US for support with PQRS.


The Physician Quality Reporting System (PQRS) is often seen as one of the most complex CMS quality reporting programs, in part because of the large number of options that are available to providers participating in the program.


While having choices for participation may seem like a positive thing, it also means that eligible professionals must understand the requirements of various reporting mechanisms and then select the one that is best for them, instead of learning a single set of requirements each year.


For providers wishing to report PQRS, there are five reporting mechanisms to choose from for reporting quality measures to CMS:


  •           Claims-based reporting.
  •           Registry reporting.
  •           Qualified Clinical Data Registry (QCDR) reporting.
  •           Electronic Health Record (EHR) reporting.
  •           Group Practice Reporting Option (GPRO).

The reporting requirements for each mechanism differ, sometimes in small ways, so it is important to understand the requirements necessary for each reporting option to select the one that is best for your practice. For example, not all quality measures can be reported via each reporting mechanism, which means your practice will need to select a group of quality measures that is applicable to your practice while also evaluating the different reporting mechanisms that are available.


Avoiding the PQRS Payment Penalty


The PQRS program requires providers reporting individual measures under any mechanism to report at least 9 quality measures covering at least 3 National Quality Strategy domains. For each measure, you must report for at least 50% of applicable Medicare Part B patients seen during the calendar year. If you’ve reported in past years, you know that providers had the option to report a certain number of quality measures to earn a payment incentive or a smaller number of measures to simply avoid the payment penalty. This year, because there is no incentive payment, there is only one set of requirements.


If you cannot report 9 measures due to lack of measures applicable to their specialty can report fewer than 9 for the required number of patients and still avoid the penalty. However, they will be subject to additional evaluation by CMS under the Measure Applicability Validation (MAV) process to ensure there were not other eligible measures to report.


Cross-Cutting Quality Measures


In addition, providers who bill for at least one face-to-face encounter during the calendar year and opt to report PQRS via the claims or registry reporting mechanism must report at least one cross-cutting measure as part of the total reporting requirements in order to avoid future payment penalties. Cross-cutting quality measures are non-disease specific measures designed to encourage preventive care and care coordination for all Medicare beneficiaries.


2016 Cross-Cutting Measures Requirement


In order for EPs to satisfactorily report PQRS measures, EPs or group practices are required to report one (1) cross-cutting measure if they have at least one (1) Medicare patient with a face-to-face encounter. A cross-cutting measure is defined as a measure that is broadly applicable across multiple providers and specialties. The Centers for Medicare & Medicaid Services (CMS) defines a face-to-face encounter as an instance in which the EP billed for services such as general office visits, outpatient visits, and surgical procedure codes under the Medicare Physician Fee Schedule (MPFS). CMS does not consider telehealth visits as a face-to-face encounter.


At least 1 cross-cutting measure must be satisfactorily reported for those individual providers with face-to-face encounters. CMS will analyze claims data to determine if at least 15 cross-cutting measure denominator eligible encounters can be associated with the individual eligible professional. If it is determined that at least 1 cross-cutting measure was not reported, the individual eligible professional with face-to-face encounters will be automatically subject to the 2018 PQRS payment adjustment. For those individual eligible professionals with no face-to-face encounters as found within the 2016 PQRS List of Face-to-Face Encounters, CMS would not require the reporting of a cross-cutting measure.


FOR MORE INFORMATION PLEASE CONTACT:

HPP Management Group, Corp.

Developers of the AccuChecker Product Line


Phone: (305) 227-2383

Email: sales@accuchecker.com

Website: http://www.accuchecker.com