Roji Intel Blog

Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 14, 2015

How to Organize Your Academic Medical Center for PQRS 2015 Success

Take a deep breath. The last-minute flurry of adjustments and updates to last year’s PQRS reporting is over. And—brace yourselves. It’s time to dig into PQRS 2015, which, if you’ve been following our posts, requires a whole new level of rigor to avoid penalties under Pay for Performance. (Download our free eBook, Insider’s Guide to PQRS 2015 Reporting, if you need to catch up.) Nowhere are the new reporting complexities greater than for Academic Medical Centers (AMCs).  Everyone is scrambling to ensure that workflow adjustments sync with new reporting requirements and general measure changes, but AMCs must contend with additional…
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Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 31, 2015

ACO v Group Practice P4P: How Medicare Costs and Quality Calculations Affect Your Bottom Line

Now that Value-Based Health Care defines the landscape, reporting for revenue is on its way out. Value-based quality is in. Medicare’s transition to Pay for Performance gives providers just three options—and no out—for participating in reimbursement models that reward for higher quality and lower cost: Build or participate in an Accountable Care Organization; Report PQRS and submit to the risk of the practice-based Value-Based Payment Modifier; Receive automatic financial penalties. Given that the last option is not really viable, which way should providers participate in Medicare’s Value-Based Health Care? An Accountable Care Organization (ACO) is a network-based model for managing…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 3, 2015

PQRS Catch-22 for Specialists: How Medicare’s Division of Measures Can Put You at Risk for Penalties

If you are a specialist, maintaining your Medicare revenues just became more challenging. As of 2015, CMS now requires nine measures instead of three for PQRS reporting. They provided a partial reprieve by reducing the completion rate from 80 percent to only 50 percent. However, successful PQRS reporting is all or nothing—failure to report all nine measures within three domains will result in a penalty for both PQRS and the Value-Based Payment Modifier (VBPM) of 6 percent total in 2017. With more than 200 measures to choose from, you may wonder what’s the problem; surely you can find nine that…
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Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceValue-Based Payment Modifier
January 20, 2015

Avoid PQRS and VBPM Penalties and Achieve Long Term Revenues: How to Choose the Right QCDR

Can you optimize your Value-Based Payment Modifier (VBPM) quality and cost profile to demonstrate better outcomes than others and avoid both PQRS and VBPM penalties at the same time? Yes: Use a Qualified Clinical Data Registry (QCDR) to do both. In 2014, the initial year of QCDR reporting, providers had the opportunity to report non-PQRS measures, but still get credit for participating in PQRS. This year, Medicare has provided additional freedom by giving QCDRs the chance to report 30 non-PQRS measures for PQRS, up from last year’s 20. Providers are required to report an additional outcome measure this year (two,…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
January 6, 2015

Medicare Is Playing by 2015 Rules—Are You?

Does it feel like 2015 yet? While we may fill out paperwork that reads “2014 2015” for the next few weeks, 2015 is here—and it’s different. Do you need evidence? The 2015 Medicare Physician Fee Schedule is officially in effect.  Several hundred pages within the 1200-page “Final Rule” describe the rules for the 2015 Physician Quality Reporting System (PQRS) and the 2017 Value-Based Payment Modifier (VBPM). Make no mistake—there is no transition period; these rules are in place today whether you’re ready or not. So, now that we’re playing by 2015 rules, what do you need to know? PQRS 2015 Is…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
December 30, 2014

New Year’s Resolution: Know the Difference Between PQRS and Meaningful Use

No one wants another CMS penalty letter this coming year. Especially after the past two weeks, when many providers from coast to coast learned that their Medicare Part B reimbursements in 2015 will be cut by 1.5 percent, since they were eligible but did not participate in PQRS 2013. Caught by surprise, some providers were shocked to discover that their successful participation in Meaningful Use (MU) did not fulfill PQRS requirements—and they were hit with the penalty. It certainly pays to understand the difference between these two Medicare initiatives. Both MU and PQRS are intended to improve the level of care…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry Reporting
December 16, 2014

Season’s Greetings from CMS: You Owe 1.5 Percent for a PQRS Reporting Failure

‘Tis the season to be jolly—unless your health care organization is one of many last week that received a letter from the Centers for Medicare and Medicaid Services (CMS) informing you that at least one of your providers was eligible to participate in PQRS in 2013, but failed to do so—and that a penalty is coming in 2015. Those who did not successfully report at least one PQRS measure in 2013 will only be reimbursed 98.5 percent on all allowable 2015 Medicare Part B charges—a 1.5 percent cut.   Ready or Not, the Penalties Were Based on 2013 PQRS Reporting…
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Dave Halpert 0
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PQRS ReportingValue-Based Payment Modifier
November 6, 2014

Final PQRS 2015 Reporting Rule: Higher Penalties and Tougher Requirements

Looking for a good bedtime read? CMS has finalized its 1200-page Medicare Physician Payment System rule for 2015. While the full version is a sure cure for insomnia, buried within are two areas worth your attention: 2015 PQRS Reporting, and Medicare’s Value-Based Payment Modifier (VBPM). Central to Medicare’s value-based health care efforts, both impose stiffer penalty risks for physician groups in 2015. Here are key rule highlights for these two programs, modified slightly from the proposed rule.   Higher Penalties for PQRS Non-Reporting Failure to report PQRS triggers two penalties: a PQRS non-reporting penalty of 2 percent, plus a VBPM non-reporting penalty…
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