In recent weeks, the Centers for Medicare & Medicaid Services (CMS) sent correspondence to a number of members, practitioners and billing companies detailing how the PQRS payment adjustment may affect their covered professional services in 2015. CMS sent these letters to Eligible Professional(s) (or their billing companies and departments) noting of their non-participation in the Physician Quality Reporting System (PQRS) in calendar year 2013 (CY). EPs and group practices receiving a PQRS payment adjustment in 2015 will be paid 1.5% less than the PFS amount for services rendered January 1-December 31, 2015.
PQRS 2013 used a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). Under PQRS, covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS).
Anesthesiologists and other anesthesia practitioners whose professional services are paid under the Medicare PFS are considered eligible professionals. To the extent that EPs are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments.
If you believe that you reported a sufficient number of PQRS measures to CMS in 2013, you may submit an appeal on your 2015 PQRS payment adjustment. CMS detailed the steps in a fact sheet earlier this year.
Measures that were applicable to anesthesiologists and anesthesia providers in 2013 included PQRS #30: Timely Administration of Prophylactic Parenteral Antibiotics, PQRS #76 Antibiotic, PQRS #76 Prevention of Catheter-Related Bloodstream Infections (CRBSI) and PQRS #193 Perioperative Temperature Management. Measure specifications for that year are listed on the CMS webpage for PQRS 2013.
ASA is currently in the process of updating our PQRS webpage for reporting for calendar year 2015. For basic information on PQRS, including rules and regulations for PQRS 2014, reporting mechanisms and criteria, please visit the ASA website.