APA Practice Organization (APAPO) PQRSPRO 2016 Registry Guide

The APA Practice Organization (APAPO) and PQRSPRO have partnered to offer this guide to help you determine the best approach for your successful PQRS reporting. If you are looking to comply with 2016 PQRS requirements and avoid the 2% payment adjustment that will be assessed for non-reporting in 2016 on all 2018 claims, the PQRSPRO registry will help you get there!

Just register and select your options prior to January 31, 2017.  You will have until Feburary 15, 2017 to complete your submission.

The following are three 2016 PQRS scenarios of various mental and behavioral health professionals for you to explore. In all of these cases, the steps to successful reporting include:

1. Determine the appropriate measures for your patient population

2. Identify the approach for gathering patient data from your records (or claims resources)

3. Establish the most suitable method and/or personnel for inputting your data

Carol Pansophy – Health Psychology

Dr. Pansophy works in multiple institutions, billing claims under her own individual NPI and Tax ID without electronic records or a billing service. After reviewing the options and, knowing her patient population, she determined that she was able to report the full 9 measures in 3 National Quality Strategy domains, including 1 cross-cutting measure.

She chose her measures on her Dashboard in PQRSPRO, which generated both online patient data entry and tips, along with printable PDFs to guide her gathering of 50% of her Medicare patient visit data for the applicable measures.

She then contacted PQRSPRO to generate a spreadsheet and entered her data, with each row representing a single patient visit. Once uploaded, Dr. Pansophy reviewed her performance and validation report, made a few adjustments to individual records to accurately reflect the patient data and submitted her data to PQRSPRO for final validation and successful submission to CMS!

Brian Axon – Neuropsychology

Since he is engaged mainly with degenerative cases in institutional settings, it was easy for Dr. Axon to choose his approach. He selected the Dementia Measures Group, which only requires manually entering a sample of 20 patient visits (11 of which are Medicare) into the interactive APAPO PQRSPRO system. He gathered his 20 patients from his EHR, entered, and submitted his data in an afternoon!

Susan Lenity – Psychotherapy

Dr. Lenity is in private practice and treats many individuals on Medicare, but most do not seem to ‘fit’ the available 2016 PQRS measures. She was unable to identify 9 measures across 3 NQS domains that apply to her patients and expects to have her reporting reviewed under Medicare’s MAV* process. She reviewed her options and found all of measures that she could report.

Dr. Lenity contacted her billing agency to identify the appropriate Medicare patient visits. Knowing that a spreadsheet-upload option is available, she then contacted PQRSPRO to generate a spreadsheet, with each row representing a single patient visit, for inputting her data for upload.

Her billing agency then completed the spreadsheet with 50% of her Medicare patient visits. She then sent the spreadsheet to PQRSPRO for upload. Once uploaded, Dr. Lenity reviewed her performance and validation report, made a few adjustments to individual records to accurately reflect the patient data and submitted her data to PQRSPRO for final validation and successful submission to CMS!

* Measures Applicability Validation (MAV) Process

If your patient population/practice/specialty does not meet the required criteria for reporting 9 individual measures from 3 NQS domains, including at least 1 cross-cutting measure, reporting 1-8 measures is subject to the CMS Measures Applicability Validation (MAV) process.

If a provider or GPRO reports less than 9 measures, the MAV Process allows CMS to conduct a claims audit, applying a ‘clinical relation/domain test’ comparing ‘clusters,’ or sets of closely related measures, to determine whether additional measures and/or domains are applicable to the practice and could/should have been reported. If CMS finds that there are additional measures applicable to the practice within the reporting group or individual providers’ claims for the reporting period, the PQRS submission will fail and will not avoid the -2% Payment Adjustment and associated VM adjustments in 2018. There are a number of educational resources available on the CMS website regarding the MAV Process. Note: if a MAV Cluster does not include a cross-cutting measure(s), at least one cross-cutting measure must be also be satisfactorily reported for those individual providers or group practices with face-to-face encounters in order to successfully avoid the -2% Payment Adjustment and associated VM adjustments in 2018.

I want to compliment you and your colleagues for fine work.

Practice Administrator, Internal Medicine, Saint Augustine, FL

I've looked at all of them now and I'm convinced that yours is the best registry. So professional, so simple to use and backed by knowledgeable, personal support. I'm confident that I'll get PQRS reporting right!

Private Group Practice, Colorado

This is an intuitive interface that gathers just the info you need and nothing more. Whoever put it together had a good understanding of the info needed and how to set it up logically.

Physician, General Practice Network, Greensboro, NC

I recommended this solution to my colleagues and they're signing up too!

Physician Assistant, Family Care Group Practices, Chicago, IL

FYI, we did get a nice check from CMS (over $20,000!) so it is well worthwhile.

University of Pennsylvania

"I didn't know that I could have it any better. Somebody needs to let others know about all of the benefits of PQRSPRO!"

RN/Coder, Private Cardiology Practice

About 80% of our patient populate are Medicare, so CMS PQRS program incentives have been very lucrative for us.

RN/Coder, Private Cardiology Practice

We used a popular, more expensive PQRS Registry last year and had issues with the website but could not get anyone on the phone and had to leave voicemail and follow-up with an email.  For the money that we paid, they should have better customer service. PQRSPRO customer service is a Rolls Royce compared to the Volkswagen I experienced last year. When I called, I spoke to someone right away!

RN/Coder, Private Cardiology Practice

The PQRSPRO Registry system was easier to use than the other one.  Chart abstraction was simple and easy to understand and all measure questions were asked at once.  The other system made me wait for a prompt to move on once I answered one question – a much slower process.

RN/Coder, Private Cardiology Practice

The cost of PQRSPRO is much more reasonable than any other!

RN/Coder, Private Cardiology Practice

The final measure report was great and will also be useful for submitting to our malpractice insurance carrier to qualify for a discounted premium rate.

RN/Coder, Private Cardiology Practice

Users reported receiving up to $70,000 from participation in 2010 via our system.

President, Healthmonix

We are very happy with you and your company. Thank you for all of you efforts.

After trying for a couple years to receive the bonus, we finally received it this year using your system.

Your support has been awesome!

I wish we would've known about you three years ago! This was a breeze!

Group Cardiology Practice, Illinois

We are very satisfied with your process and service and confident that our practice will benefit from the incentive and avoid the penalties.

Intern, Ophthalmology Practice

APAPO provides PQRS registry reporting for psychologists and other mental health professionals. Register for 2016 now!

CMS Disclaimer

If reporting for Physician Quality Reporting System (PQRS) through another Centers for Medicare and Medicaid Services’ (CMS) program (such as the Medicare Shared Savings Program, Comprehensive Primary Care Initiative, Pioneer Accountable Care Organizations), please check the program’s requirements for information on how to report quality data to earn a PQRS incentive and/or avoid the PQRS payment adjustment.

Please note, although CMS has attempted to align or adopt similar reporting requirements across programs, eligible professionals (EPs) should look to the respective quality program to ensure they satisfy the PQRS, Electronic Health Record (EHR) Incentive Program, Value-based Payment Modifier (VM), etc. requirements of each of these programs.

You should not select that you participate in the Medicare PQRS-EHR Incentive Pilot when you attest to this question on the CMS website. The Healthmonix Registry is NOT a qualified submission vendor for clinical quality measures for purposes of meaningful use.