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ODs must perform PQRS reporting in 2013 to avoid 2015 penalties

February 7, 2013

Microsoft Word - 3 - A - 2013 AOA PQRI Summary Chart (4).docxBy Rebecca H. Wartman, O.D.

While there are only a few minor edits to the Physician Quality Reporting System (PQRS) for 2013, it is an important year. If a provider (that means you) does not participate in 2013, they will be penalized in 2015. (See http://bit.ly/VQqL6o.)

Successful reporting means recognition for providing quality care for the individual doctor and for the optometric profession, as well as more dollars in the coffers of the optometrist and avoidance of the 2015 penalties.

The PQRS bonus for 2013 will be 0.5 percent of individual Medicare allowable on all claims filed in 2013. This includes all claims, even those claims where the addition of PQRS measures were not appropriate.

The success level for claims-based reporting is again reporting at least three different PQRS measures on at least 50 percent of the claims where the proper diagnosis and procedure codes are filed. This does not mean a provider has to file three PQRS measures on 50 percent of Medicare claims.

The provider needs to choose at least three different PQRS codes to report for 2013 and then report these PQRS codes consistently on at least 50 percent of the appropriate claims filed.

While there are 241 PQRS measures for 2013, and optometry need only be concerned with seven of these measures even though we could report on several more.

An easy way to participate successfully in PQRS is to only consider glaucoma, diabetes and macular degeneration diagnoses.

There are two changes of note in the seven PQRS measures for diseases commonly seen in an optometry practice.

The main change is the diagnosis codes allowed for the two glaucoma measures. Codes 365.70 to 365.74 were eliminated for measures #12 and #141.

The other change is the assumption that if a patient with macular degeneration is already on Age-Related Eye Disease Study (AREDS) antioxidant supplements, the provider has already discussed the pros and cons of these supplements for that particular patient (measure #140).

The electronic health records measure 124 was retired in 2013 because Meaningful Use is well under way, making this measure obsolete.

Electronic prescribing remains a stand-alone initiative. The guidelines for this initiative have not changed for 2013.

Optometrists remain exempt from any penalty for not using electronic prescribing through 2014 when this initiative is scheduled to end. Keep in mind that electronic prescribing is part of Meaningful Use.

The final change of note would be the addition of the applicable ICD-10-CM diagnosis codes to the listing of applicable diagnosis codes. This was done to aid providers in preparing for the Oct. 1, 2014, mandatory transition from ICD-9-CM to ICD-10-CM.

AOAExcel™ resources

AOAExcel™ has all the information and details for successful participation in PQRS 2013.

Important links:

AOAExcel™ – www.excelod.com
Centers for Medicare & Medicaid Services:
PQRS https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/ MeasuresCodes.html
e-Rx https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/ index.html

One comment

  1. I’ve taught coding and billing for Optometry for over five years (185 seminars). The feedback from thousands of Optometrists and their staff–PQRS is not that bad. Do not be scared of it. Once you learn the codes and it becomes a habit, then the incremental effort is minimal. Very good article. Good job.

    Jeffrey Restuccio, CPC, CPC-H
    Coding Consultant for Eyecare



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