ABC's of Quality Reporting : Your 2016 Roadmap to Navigating Health IT Initiatives, Including PQRS, Value-based Modifier, and the Merit-based Incentive Payment System

Table of Contents Acknowledgments About the Author Editor’s Note Chapter 1: Understanding Quality Reporting Context The Path for 2016 Looking Back The Road Ahead Financial Impacts of CMSQuality Programs PQRS Basics Avoiding Payment Adjustments Eligibility Requirements Eligible but Not Able to Participate Scenario 1: Does not bill services payable under the MPFS Scenario 2: Does not submit individual rendering National Provider Identifier (NPI) Naming Conventions Reporting Periods Individual versus Group Reporting Group Practices Defined Why Choose One or the Other PQRS Measures Where Measures Come From Defining Quality Measures Calculating Quality Measures Determining a Quality Measure’s Reporting Frequency Performance Timeframes Types of Measures Availability of Measures Measure Selection Strategy Individual Measures Measures Groups Specialty Measure Sets Cross-Cutting Measures PQRS Reporting for Pathologists Chapter 2: PQRS Reporting Methods Claims (I) Registry (I) (G) Electronic Health Record (EHR) (I) (G) EHR-Direct versus DSV Qualified Clinical Data Registry (I) Group Practice Reporting Option (GPRO) Web Interface (G) Web Interface Quality Measures Certified Survey Vendors (CAHPS for PQRS) (G) Chapter 3: Understanding the Value-based Payment Modifier (VM) Program Calculating a VM Score Quality Composite Cost Composite Risk Factors of a Practices Attributed Beneficiaries How Does CMS Determine National Benchmarks? Quality Tiering Quality Resource and Use Reports (QRURs) Performance Highlights Page of the QRUR Informal Review How to Request an Informal Review Informal Review Decision Chapter 4: Public Reporting of Quality Physician Compare Chapter 5: Physician Quality Reporting System (PQRS) Best Practices Getting Help Frequently Asked Questions (FAQs) Acronymns Appendix Claims-based Reporting Coding Measure Applicability Validation (MAV) Clinical Relation Test Minimum Threshold Test