PQRS vs. CQMs—What’s the Difference and How Do I Report Them?

There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they still don’t), and how to report the correct information.

A (Brief) History

The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.

Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.

A Confluence of Program Changes

Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA. Continue reading

Will the Implementation of ICD-10 Interfere with Meaningful Use?

No, but…Michael_Opsteegh

The implementation of ICD-10 does not affect your meaningful use (MU)  calculations. While the compliance date for ICD-10 is October 1—well into your meaningful use reporting year—you will not see any impact on your MU calculations.

It seems strange to think that such a disruptive change as ICD-10 wouldn’t impact your MU attestation. The transition from ICD-9 to ICD-10 applies only to diagnosis codes in offices and outpatient settings. The MU core and menu set measures do not require specific diagnosis codes. Therefore, ICD-10 will not impact your MU calculations.

The clinical quality measures (CQMs), however, are very dependent upon the proper diagnosis codes being in place. Eyefinity has you covered in this regard. Our 2014 Edition CQMs will accept your ICD-9 and your ICD-10 codes. Even when you switch midway through your reporting period, your calculations will reflect both code bases.

Here’s the but…

There’s one small detail that you may need to address one time. You’ll need to add any ICD-10 codes  to your clinical decision support rules to ensure that your diagnosis still trigger the correct clinical decision alerts (Stage 1, core measure 10; Stage 2 core measure 6).

What does 2015 hold for meaningful use?

Since the meaningful use program began, there has been an abundance of challenges to successfully demonstrate and attest.  According to CMS, only 4% of eligible professionals (EPs) have successfully attested to Stage 2, and beginning this month, 257,000 EPs will be assessed penalties as a result.

Progressively Tougher RequirementsPROOF_19922DR_fixit_blog
As the program currently stands, beginning this year, the meaningful use demonstration period is required to run for the full 365 days of the year, rather than 90 days as required in previous years. In an effort to mitigate the additional challenge and facilitate successful attestation, Representative Renee Ellmers introduced the Flexibility in Health IT Reporting Act (Flex-It) in 2014.

If passed, Flex-It will reduce the demonstration period in 2015 to 90 days, rather than the full year that is currently required for those attesting for either Stage 1 or Stage 2. Those in their first year of Stage 1 will attest to a three month period regardless of the outcome of the rule. In 2015, EHR solutions must be 2014 certified to qualify for meaningful use attestation.

Though the act was submitted, no decision was made in 2014. Not to be dissuaded, Rep. Ellmers has reintroduced the bill in January, and has the backing of legislators from both the Democrat and Republican parties.  Stay tuned, we’ll keep you posted on the status of the Flex-It Act, when its fate is decided, and all of the latest news on meaningful use.

Do you have questions about meaningful use? We’re here to help! Contact us at meaningfuluse@eyefinity.com.

Meaningful Use Hardship Exceptions Extended

Featured imageCMS has reopened the submission period for hardship exception applications, allowing eligible providers (EPs), like you, one last chance to avoid the 1% Medicare payment penalty in 2015. The new deadline is November 30 at 9:59 pm Pacific. You must complete the Hardship Exception Application and email it to ehrhardship@provider-resources.com.

Chasing Deadlines

October 1 was a frenzied rush as thousands of EPs attempted to attest to meaningful use to avoid the 1% Medicare penalty in 2015. The crushing volume strained the attestation system as well as the call centers of EHR vendors. Frustration increased when EPs attempted to attest to the 2011 Edition criteria under the recent delay because CMS’s attestation system had not been retrofitted to accommodate the revised rules.

Breathing a Collective Sigh of Relief

To alleviate the situation, CMS has decided to reopen the submission period for hardship exception applications after a three-month hiatus. EPs who were stuck in the snarl of October 1 will surely appreciate this extension.

Reading the Fine Print

This extension is not an outright postponement of Medicare penalties in 2015. To be eligible for a hardship exception, you must meet the following criteria:

  • You were unable to fully implement a 2014 Edition certified EHR because your certified software was not available soon enough for you to install, train, and use prior to July 1
  • You were unable to attest by October 1, 2014, using the flexibility options provided in the 2014 Flexibility Rule

Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.

Catch a Break – Hardship Exceptions to Meaningful Use

Meaningful_Use_sticknoteAre you a Medicare provider who has yet to participate in meaningful use? If so, an important deadline is approaching quickly. July 1 is the deadline to begin meaningful use Stage 1 to attest before Medicare payment adjustments take place in 2015. That’s right, you must have installed a 2014 Edition certified EHR, begin your three-month reporting period on July 1, and attest on October 1 to avoid the 1% penalty.

If you’re in your second year of Stage 1 or beginning Stage 2 in 2014, you have two opportunities to begin your reporting period: July 1 and October 1.

Are you afraid you’re not going to make it?

Not to worry. The CMS recognizes that there are valid reasons that render an undue hardship or eliminate feasibility for a practice to participate. Those valid reasons will prevent payment adjustments for a year. Exceptions are segmented into six categories:

  • Infrastructure – EPs practicing in an area where internet access is not available or feasible to attain
  • New EPs – EPs who began their practice without sufficient time to begin meaningful use and attest before 2015
  • Unforeseen Circumstances – In the event of a natural disaster or other unforeseeable event
  • Patient Interaction – EPs who do not have face-to-face or telemedicine interaction with patients, or who do not need to follow-up with their patients
  • Multiple Locations – Applies when it causes the EP to lose control over the availability of certified EHR for more than 50% of patient encounters
  • Vendor Issues – EPs whose EHR vendor has been unable to attain 2014 ONC certification for their EHR*

Still not sure if you qualify for the hardship exception? Use the CMS online tool to determine if you qualify. Don’t sit back just yet. You must file for an exception by July 1, 2014, to avoid penalties in 2015. Exceptions are valid for one year and then must be renewed.

If your hardship exception is approved you’ll skip your current year of meaningful use and advance to the next year when you resume. For example, if you were scheduled to demonstrate your second year of Stage 1 in 2014, you would skip to your first year of Stage 2 in 2015.

While some providers may file a hardship exception to postpone their meaningful use adoption and see if a recent CMS proposal will allow them attest, there is no guarantee your exception will be approved. Our 2014 Edition certified products are ready and available now to help you meet your meaningful use requirements.

For more information and specific details about the hardship exception, view the CMS document outlining meaningful use timelines and exceptions. And of course, if you have any questions about meaningful use, contact us at meaningfuluse@eyefinity.com.

 

* While 717 EHR vendors offered certified products for the 2011 Edition of meaningful use, only 151 offer certified products for the 2014 Edition. Eyefinity’s EHR solutions are currently certified to meet the ONC 2014 Edition criteria and support both Stage 1 and 2 meaningful use. [Source: Certified Health IT Product List, accessed June 24, 2014, comparing 2011 to 2014 complete ambulatory EHRs]

Eyefinity to Host FOCUS 2013 October 2nd at Vision Expo West

FOCUS 2013

Learn how technology can enhance the patience experience and improve your bottom line

Rancho Cordova, Calif., September 13, 2013— Improving the patient experience will continue to be a key differentiator in how healthcare providers are perceived. One significant trend in providing exceptional patient experiences is the use of technology. And selecting the right technology can take what used to be considered an amenity, and have it emerge as a critical partner in the healthcare experience both for your patient as well as for your bottom line. If you want to learn how to leverage interactive patient care technology, don’t miss the Eyefinity® event “FOCUS 2013: Embracing Technology Change in your Practice,” on October 2nd at Vision Expo West in Las Vegas.

Read Entire Press Release

Closing Out 2012 Meaningful Use

MSMU VerticalAs 2012 comes to a close, many of you, who are participating in the Medicare and Medicaid EHR Incentive Programs, are going to be attesting to meaningful use for the first time. While attesting or reporting your meaningful use might seem like a daunting and nerve-wracking process, it only seems that way because it’s a new experience.

Here are some things to keep in mind and links to additional resources where you can find complete information about meaningful use, attestation, and the EHR Incentive Programs.

Attesting on Time

You must attest to meaningful use after your reporting period, and not during your reporting period. If your attestation period continues through December 31, you may then complete your attestation beginning January 1. For the Medicare EHR Incentive Program you must complete your attestation by February 28, 2013. If you are participating in the Medicaid EHR Incentive Program, check with your state’s Medicaid for applicable deadlines.

Even if you can’t officially attest until January 1, you will want to perform steps 1 and 2 below to head off any potential shortcomings.

Navigating the Attestation System

Each doctor must attest individually, you cannot attest as a practice. Follow these steps to ensure your attestation goes smoothly:

  1. In ExamWRITER, click the Reports menu and run the CMS Meaningful Use Reporting and CMS Quality Reporting. For complete instructions, press F1 for help.
    – The meaningful use report lists only those measures that require percentages. The unlisted measures require a simple yes or no answer.
    – If your percentages are low in some of the menu measures, don’t fret. You only need to report on 5 out of the 10 menu set measures, provided one of them is menu 9 or 10.
    – Many of the measures may be satisfied by claiming an allowable exclusion.
    – The clinical quality measures may show low percentages. That’s okay. They don’t have minimum thresholds.
  2. Practice your attestation using CMS’ Meaningful Use Attestation Calculator.
    – If your numbers are low review the “Achieving Meaningful Use with OfficeMate/ExamWRITER” or “Tracking CMS Quality Measures in ExamWRITER” documents, which can be found on our Meaningful Use Starter Kit page. If your attestation period has not ended, there may still be time to correct some shortcomings.
    – If didn’t realize that you were short in a measure until after 2012 was over, look for allowable exclusions. If no exclusion applies to you, it is too late to correct any shortcomings.
  3. Attest to your meaningful use through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.
    – Use the Attestation User Guide for Eligible Professionals for visual, step-by-step instructions.
    – Attestation is self-reported. You do not need to furnish documentation when you attest. Documentation may be required later (see “Surviving an Audit,” below).
    – If you are asked for your EHR Certification Number, refer to this knowledge base article.

Surviving an Audit

Since the EHR incentive programs are government-funded initiatives, audits are an important part of abating fraud and waste in the program. CMS will not release specific information about the nature of the audits, but they have posted some general guidelines on their Frequently Asked Questions page. While OfficeMate/ExamWRITER users have nothing to fear from these audits, we encourage you to save a printed or electronic copy of your meaningful use calculations and any communications that you have had regarding meaningful use. For example, you’ll want to save copies of the following:

  • Meaningful use report calculations
  • Clinical quality report calculations
  • Email showing that you transmitted a CCR to a colleague (core 14)
  • Checklist or documentation from your security audit (core 15)
  • A full screenshot of OfficeMate or ExamWRITER with the About window open (showing the date and the practice license information)
  • Any other documents or communications you have regarding meaningful use

Getting Paid

In theory, you can expect to see your check between six to eight weeks after attesting to meaningful use.

In reality, there are a number of factors that could delay your payment:

  • If you have not yet reached $24,000 in Medicare Part B billings, your payment will be held until you do. Your incentive payment for 2012 is based on 75% of your Part B billings up to a ceiling of $24,000, making the maximum payment $18,000.
  • If you do not bill $24,000 in Medicare Part B billings in 2012, your payment will be sent six to eight weeks after the final day to bill for 2012, which is February 28. So, you won’t see your check until April.
  • If you participated in a state Medicaid incentive program, the payment timeframe varies drastically.

Payments are made on a per-provider basis, and not per practice. Payments are based on a percentage of your allowable Medicare Part B billings. Even if your practice bills under one NPI, the incentive is determined by the rendering provider’s NPI on the CMS 1500.

Continuing Meaningful Use

For 2013, you will once again attest to stage 1, but for the entire calendar year.

For 2014, you will attest to 90 days of stage 2 meaningful use (we’ll be communicating with you about that throughout 2013 and 2014).

Planning to Qualify for a 2012 Federal Incentive Payment?

You must begin 90 days of meaningful use by October 3, 2012! Follow this step-by-step checklist to ensure you’re on track.

Upgrade

Visit myinstallcenter.officemate.net to upgrade to OfficeMate/ExamWRITER® v10, the certified, complete EHR system.

Upgrade as soon as possible to ensure you’re up and running well before the October 3, 2012, deadline to start demonstrating meaningful use.

Review the Hardware & System Requirements to ensure you meet or exceed the minimum hardware and system.

If your hardware doesn’t meet software requirements, contact trusted OfficeMate Certified Partners, North Shore Computer or Think Smart to assist.

Register

Register on the Centers for Medicare and Medicaid (CMS) website by October 3, so you’re ready to demonstrate meaningful use.

Train

Visit the Meaningful Use Resource Center for intuitive resources to quickly get you up and running with v10, and help you understand how to achieve meaningful use.

Don’t miss our Ask the Expert session on meaningful use this Thursday, September 27. Submit your meaningful use questions and listen to what other people are asking. Register now!

Fulfill

Fulfill the mandatory 90 days of meaningful use (October–December 2012).

Use the Meaningful Use Reporting Calculator in ExamWRITER, under the Reports menu, for real-time calculations, and to measure and obtain feedback on your progress.

Collect

Check the Attestation User Guide on the CMS website for the complete attestation process.

Be one of thousands of ODs in the country to qualify and receive your stimulus payment—by using the industry leading EHR system.

Ask the Expert Classes on Meaningful Use

Today’s blog article is written by Shari H.  Shari is an OfficeMate Implementation Consultant working remotely in North Carolina.

Eyefinity offers a wide variety of resources to help you successfully complete and attest to meaningful use using OfficeMate/ExamWRITER. For example, our Meaningful Use Starter Kit includes short videos, check lists, and instructions that describe each measure, any exclusion, and how to complete the measure. But sometimes you need additional advice, or perhaps your practice is in a peculiar situation regarding meaningful use. If you feel like you could use additional guidance, we have a class for you!

We’ll be offering a special meaningful use edition of our Ask the Expert classes. There will be three sessions available on the following dates and times:

  • Friday, August 31, 2012 at 10 a.m. ET
  • Wednesday, September 12, 2012 at 3 p.m. ET
  • Thursday, September 27, 2012 at 10 am ET

The Meaningful Use Ask the Experts class will answer your questions on what you need to do to meet the requirements for attestation in 2012. The presenters of this class have taught hundreds of ECPs to successfully demonstrate meaningful use to collect thousands of dollars in payments with OfficeMate/ExamWRITER.

The Ask the Expert series has been very successful in helping our clients answer specific questions in all areas of the program such as examinations, billing, and inventory. We know that you have questions. These classes give you a chance to ask them and speak one on one with an expert. Many clients have attended these sessions just to listen to what other clients are asking. This is your time, your forum, your questions.

This special class was created to take the scariness out of attestation. Doctors and practice managers will benefit greatly from attending one of the scheduled meaningful use sessions. The class has been scheduled with your convenience in mind. 24 hour advanced registration is all that is needed. You may submit up to three questions upon registration. The format will be an open forum (45 minute to 1-hour sessions).  If no questions have been submitted the presenters will review the meaningful use resources available.

Register for an Ask the Expert—Meaningful Use session:

  1. Go to officemate.webex.com.
  2. Click the Training Center tab.
  3. Click the Daily tab.
  4. Use the calendar within the Daily tab to move to your desired session date.
  5. Click the Register link on the right side of the session in which you want to enroll.
  6. Enter your contact Information.
  7. Click Register.

We hope that you will take advantage of this Ask the Expert class on meaningful use. As always, we welcome your feedback

#1 for Most ECPs Receiving EHR Incentive Payments

Qualify for EHR incentive money by October 3More than 1,300 eyecare providers (ECPs) have demonstrated meaningful use and collected thousands of dollars in EHR incentive payments—with OfficeMate/ExamWRITER v10, the certified, complete EHR.  That’s almost half of all eyecare professionals who have received payments to date!

Eyefinity is proud to provide the industry’s leading product that has helped the most ECPs receive incentive payments.

See how OfficeMate/ExamWRITER v10 helped these two doctors fulfill meaningful use and secure incentive payments.

Amanda Schmidt, OD, Northwest Optometry Associates, Fresno, California

“I wanted software that would seamlessly integrate our back office with front office billing. I also wanted to be sure that the software company I selected would be around for awhile. It was satisfying to know that Eyefinity was a stable, well-established company with reliable technical support. The most challenging part was understanding what meaningful use was. But the Eyefinity meaningful use resources did an excellent job explaining it. I’m just one doctor with one office, and I received more stimulus money than I thought I would!”

James Hertzog, OD, Hertzog Family Eye Care, Cabot, Arkansas

When asked what he considered most important when selecting a certified EHR system, Dr. Hertzog required “ease of use, cost, and a comprehensive product.” OfficeMate/ExamWRITER v10 topped the list.

“The Meaningful Use Report in ExamWRITER is helpful in reminding me what information needs to be collected to demonstrate meaningful use. If you haven’t upgraded to a certified EHR and fulfilled meaningful use, do it now. It’s easy and the longer you wait, there will be less stimulus funds available to offset any costs to implement EHR.”

Find out how you can qualify for incentive payments using OfficeMate/ExamWRITER. The last day to begin meaningful use if October 3.