Use PQRS measures on Medicare claims

Use of quality measures are still the standard for physicians submitting claims to traditional Medicare.  In fact, next year a new quality system will be utilized to start the implementation of the new value-based MIPS Medicare payment system. For now, things you should be doing:

  • There are four “cross-cutting” measures used on all encounters: blood pressure, meds, pain, and tobacco use
  • There are three eye disease measures for ODs: AMD, Diabetic Retinopathy, and POAG
  • One systemic disease you will use: diabetes
  • Ensure that all patient encounters for Medicare has them on the claims
  • Check Remittance Advices to ensure they are reaching the carrier

Meaningful Use 2016

Modified Stage 2 MU criteria is still in place for EHR use in 2016.  Next year, the criteria will change as the Medicare system makes a transition to the MIPS system of value-based reimbursement that ranks providers on four categories: EHR, Quality, Claims, and Practice Improvement.

MU compliance is important to avoid reduced Medicare payments as well as qualify for the last of the incentive payments.  Things you should be doing this year:

  • Computerized order entry and e-prescribing if more than 100 Rxs in the reporting period
  • Patient Education for 10% or more of encounters
  • Upload visit reports promptly for 50% or more of visits
  • Implement and check your secure email regularly
  • Review HIPAA policies and Information Security