How MHS Can Help Practices Avoid The PQRS Penalties

How MHS Can Help Practices Avoid The PQRS Penalties

The Physician Quality Reporting System (PQRS), is the beginning of CMS’s goal to use pay-for-performance and quality of care instead of paying fee for service.  Submitting the correct PQRS codes can seem overwhelming.  However, if providers do not submit the PQRS codes correctly to Medicare, there will be financial penalties applied to future claims.

The Penalties For Not Participating In The PQRS Initiative

Penalties for Not Participating in or Following the Guidelines of PQRS are the Following:

If you did not participate in or follow the guidelines of PQRS in 2014 there is a 2% penalty on each of your claims for 2016 plus 2% is deducted for sequestration.

If you did not participate in or follow the guidelines of PQRS 2015 there will be a 2% penalty on each of your claims for 2017, plus 2% is deducted for sequestration.

If you do not participate in or follow the guidelines of PQRS in 2016 there will be a 2% penalty on each of your claims for 2018*, plus 2% is deducted for sequestration.

*If you are an individual provider and do not participate in PQRS in 2016, the penalty will be 4% on each claim in 2018  plus the 2% that Medicare already deducts 2% for sequestration.  

 

Methods of Reporting for Individual Providers and/or Small Practices

Claims reporting                          Registry reporting

 

MHS is collaborating with Dolby Healthcare Consultants to help practices participate in PQRS in 2016 and choose how to report.  Dolby Healthcare Consultants has a proven track record assisting providers in deciding:

 

  • How the practice will report the PQRS measures in 2016
  • Which PQRS codes the practice should include when using Claims reporting while keeping in mind:

 

    • How often the code has to be submitted.
    • The age requirements for the code.
    • The diagnosis associated with each code, if a diagnosis is applicable.

 

If you are interested in learning more about avoiding these costly PQRS penalties please call Medical Healthcare Solutions at 800-762-9800 X102 for a free consultation.