Fast FAQs for Anesthesiologists in PQRS 2016:
What is the Physician Quality Reporting System (PQRS)?
PQRS is a quality reporting program that uses negative payment adjustments to promote reporting of quality information by individual EPs and group practices.
Who is eligible to participate? Who is an Eligible Professional (EP)?
Anesthesiologists, pain medicine physicians and other clinicians whose professional services are paid under the Medicare PFS are considered eligible professionals (EPs). To the extent that EPs are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments.
For PQRS reporting, there are no hardship or low-volume exemptions for the PQRS payment adjustment. All EPs who furnish Medicare Part B covered professional services must participate in the PQRS each year by meeting the criteria for satisfactory reporting.
Why is participation in PQRS important?
Non-participation or failure to satisfactorily report or satisfactorily participate in the 2016 reporting period will subject you to a 2 percent payment adjustment on your covered professional services in 2018. Non-PQRS reporters will also experience an additional penalty under the Value-Based Payment Modifier (VM). For additional information on the VM, please visit the VM Frequently Asked Questions webpage.
How do I successfully participate?
EPs are generally required to report nine (9) measures across three (3) National Quality Strategy domains. Each reporting mechanism includes different criteria for satisfactorily reporting or satisfactorily participating. The EP may choose which measures to report so long as the EP meets the criteria for reporting. Practices participating in the claims-based or qualified registry reporting mechanisms who do not have 9 measures to report must report on all applicable measures and successfully pass the Measure-Applicability Validation process.
Eligible Professionals (EPs) may participate using any of the below reporting methods:
Practices wishing to report via the Group Practice Reporting Option (GPRO) may report, if available, via the qualified registry GPRO and QCDR GPRO options.
What is the Measure-Applicability Validation (MAV) process?The MAV process applies to EPs and Group Practices reporting via claims-based or qualified registry mechanisms, and is automatically triggered when an EP reports fewer than nine measures covering less than three NQS domains. For payment adjustment considerations, the MAV process determines whether an EP, who submitted data on fewer than 9 PQRS measures across 3 NQS domains, should have submitted additional measures to PQRS. Eligible professionals who fail MAV are subject to the 2018 payment adjustment. Information on how the 2016 PQRS MAV is applied is found on the CMS Analysis and Payment webpage.
Please visit the CMS webpages listed below for additional resources on PQRS reporting.
* ASA has been approved by CMS to be a Qualified Registry and a Qualified Clinical Data Registry (QCDR) in 2016. To understand the differences between the two mechanisms, please review the ASA PQRS Reporting Solutions webpage. The GPRO reporting option is not available for participating in the Anesthesia Quality Institute's qualified registry or QCDR.
For information on the 2015 reporting year, visit the 2015 PQRS Frequently Asked Questions webpage.
For information on PQRS reporting options and regulatory information, please contact the ASA Department of Quality and Regulatory Affairs at (202) 289-2222 or firstname.lastname@example.org.