Medicare Quality Program Updates
MIPS Cost Measure Field Testing 11/1/17
2017-2018 CMS Flu Coding Guide 10/12/17
2016 PQRS Reporting Dates – Q1 2017 Updated 2/23/17
New: PQRS 2016 Informal Review Process
Requests for 2016 informal review must be made between 9/9/15 and 11/9/15.
Changes to Local Coverage Determinations (LCD) – effective 4/1/15
Upcoming webinars for 2015 PQRS reporting:
PQRS:Reporting Once for 2015 and PQRS Virtual Office Hours. Details here.
Deadline change for EHR & QCDR submission of 2014 PQRS data – now March 20, 2015 at 8 pm. Click here for the details .
Filing 2014 PQRS data with QCDR/QRDA Category III? Read this to avoid potential submission errors.
2014 PQRS Reporting Timeframes Please note: 2014 PQRS data is used to determine 2016 payment adjustments.
This MLN Connects™ video presentation provides an overview of the value-based payment modifier and how it relates to the Physician Quality Reporting System (PQRS). It also provides a walkthrough of a very detailed decision tree that has been created to help physicians determine how the value modifier in 2016 will be affected by their PQRS participation this year.
Group practices and physician solo practitioners nationwide can now access 2013 QRUR quality and cost performance data for CY 2013. This is the performance period for the Value-Based Payment Modifier (VM) applied to physician payments in 2015.
The 2013 QRUR data provides clinically meaningful and actionable information to use in planning improvements in the quality and efficiency of care
VBPM Deadline: Groups of 10 or more must register by September 30
General information (includes billing, coding, provider enrollment & certification)
Open Payments/Sunshine Act
Learn the basics of Medicare quality programs with the free, on-demand CSMS webinar series.
CMS Outreach & Education
The CMS Outreach & Education page provides free resources for physicians and office staff, including the Medicare Learning Network (MLN), Innovation Center webinars and forums, compliance training and more.
Previous webinar presentations and recordings can be accessed on the Resources page of the CMS eHealth website.
PQRS: New Remittance Codes
Are you a PQRS eligible professional participating in claims-based reporting this year? Effective July 1, 2014, you will have to use the updated Remittance Advice Remark Codes (RARCs) for PQRS claims-based reporting that went into effect on April 1, 2014.
CMS has released a new FAQ with information about the updated codes.
What are the New Codes and What Do They Mean?
Eligible professionals who bill on a $0.00 Quality-Data Code (QDC) line item will receive the N620 code, which replaces the current N365 code. Also, eligible professionals who bill on a $0.01 QDC line item will receive the CO 246 N572 code.
The new RARC code N620 will be your indication that the PQRS codes were received into the CMS National Claims History (NCH) database.
The new RARC N572 with the Claim Adjustment Reason Code 246 (with Group Code CO or PR) indicates that the procedure is not payable unless non-payable reporting codes and appropriate modifiers are submitted.
Remember: The new codes will be effective on July 1, 2014. The old codes will be deactivated on the same date.