Webinar 1 - 2014 Requirements Overivew and PQRS_20140328

Webinar 1: 2014 Requirements Overview &

PQRS Wednesday, March 24, 2014 at 3:30 PM EST

Thursday, March 25, 2014 at 4:30 PM EST

EHR * PM * Patient Portal * Direct Messaging * Secure Healthcare Messaging

Requirements for EP in 2014


Demonstration of Meaningful Use (MU) [90 Days] Medicare – Last Year to Start Meaningful use is 2014 Medicaid – Last year to start meaningful use is 2016

Physician Qualitative Reporting System (PQRS) for entire 2014

Use of ICD-10 CM by October 1, 2014 Implement Updated Rules for HIPAA & Security Risk Analysis

Not Required in 2014 X eRx Incentive program ended in 2013.

Do not send eRx code G8553 for eRx . No more Requirement in 2014

Requirements for Implementing MU in 2014


Updated DigiDMS Agreement Updated Business Associate Agreement (BAA) Upgrade to DigiDMS EHR 2014 Edition certified complete EHR

Even If you are demonstrating Meaningful Use Stage 1 in 2014, You will have to use DigiDMS EHR v 14.0.1 2014 Edition Certified Complete EHR

Direct Messaging Module Patient Portal Secure eMails Training DigiDMS Meaningful Use Helpdesk (Optional)

Meaningful Use Quick Facts


“All providers must upgrade or adopt newly certified EHRs in 2014” , meaning All providers regardless of their stage of Meaningful Use are only required to demonstrate meaningful use for a three month (or 90 day) period.

Medicare Eligible Professionals beyond their first year of meaningful use must

select a three-month reporting period fixed to the quarter of the calendar year for Eligible Professionals. Providers must attest to these reporting periods no later than February 28, 2015 at 12 AM ET.

Medicare EPs in their first year of meaningful use may select any 90 day reporting period. Medicaid EPs can select any 90-day reporting period that falls within the 2014 calendar year.

MU Stage 1 had 13 Core Objectives, 5 of 10 Menu Objectives, Total 18 Objectives While MU Stage 2 has 17 Core Objectives, 3 of 6 Menu Objectives, Total 20 Objectives.

Clinical Quality Measure (CQM) Quick Facts


EPs will have to report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the EHR Incentive Programs.

All Medicare EPs have the option of submitting three months of CQM data online through the CMS registration and attestation system. Medicare EPs also have the option to submit a full year of data electronically using the QRDA format to receive credit for the EHR incentive Program and Physician Quality Reporting System (PQRS). Medicaid EPs must submit their clinical quality measurement data to their State

Medicaid Agency

Begining in 2014, EPs must select and report on 9 of a possible list of 64 approved CQMs for the EHR Incentive Programs. The 6 domains are:

Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Health Care Resources Clinical Processes/ Effectiveness

Medicare Incentive Program Participation Timeline


2011 2012 2013 2014 2015 2016 Total Incentive ($)

90D - S1 ($18,000)

FY - S1 ($12,000)

FY - S1 ($8,000)

90D - S2 ($4,000)

FY - S2 ($2,000) x $44,000

x 90D - S1 ($18,000)

FY - S1 ($12,000)

90D - S2 ($8,000)

FY- S2 ($4,000)

FY - S3 ($2,000) $44,000

x x 90D - S1 ($15,000)

90D - S1 ($12,000)

FY - S2 ($8,000)

FY - S2 ($4,000) $39,000

x x x 90D - S1 ($12,000)

FY - S1 ($8,000)

FY - S2 ($4,000) $24,000

90D: Demonstrate 90 Days of Meaningful Use S1: Stage 1 of Meaningful use FY: Demonstrate Meaningful Use for Full Year S2: Stage 2 of Meaningful Use

Medicaid Incentive Program Participation Timeline


90D: Demonstrate 90 Days of Meaningful Use S1: Stage 1 of Meaningful use FY: Demonstrate Meaningful Use for Full Year S2: Stage 2 of Meaningful Use A: Adoption of Meaningful use certified Technology

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 A ($21,250)

90D - S1 ($8,500)

FY - S1 ($8,500)

90D - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500) x X x x x

x A ($21,250)

90D - S1 ($8,500)

90D - S1 ($8,500)

FY - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500) x x x x

x x A ($21,250)

90D - S1 ($8,500)

FY - S1 ($8,500)

FY - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500) x x x

x x x A ($21,250)

90 - S1 ($8,500)

FY - S1 ($8,500)

FY - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500) x x

x x x x A ($21,250)

FY - S1 ($8,500)

FY -S1 ($8,500)

FY - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500) x

x x x x x A ($21,250)

90D -S1 $8,500)

FY - S1 ($8,500)

FY - S2 ($8,500)

FY - S2 ($8,500)

FY - S3 ($8,500)

Physician Qualitative Reporting System (PQRS) Quick Facts


By submitting PQRS for year 2014, EPs can earn 0.5% incentive and avoid 2% adjustment for year 2016.

All Measure Groups are reportable via Registry only, meaning EP can not submit Group PQRS measures via claims in 2014.

For earning incentive and avoiding penalty, Total 9 individual measures out of 3 strategic national

quality domain must be submitted for 50% of Medicare Part B and Railroad Medicare claims from Jan 1, 2014 to Dec 31, 2014.

Just to avoid penalty, Report at least 3 measures covering 1 NQS domain for at least 50% of the EP's

Medicare part B FFS Patients satisfactorily.

PQRS data can be submitted via preferred methods of Claims, Stage 2 Certified EHR OR Registry. Refer PQRS guidelines by CMS for other reporting methods.

CMS Strongly encourages all EPs and practices to begin billing 2014 QDC codes with a $0.01 charge. The RA/ EOB Denial code N365 is your indication that PQRS codes were received into the CMS

National claims history (NCH) database.

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/How-to-Report-Once-for-2014.pdf

PQRS How to Report once or individual for 2014 Medicare

Quality Programs Reporting (PQRS & CQM)?


Eligible Professionals (EPs) have a choice to report one time during the 2014 program year in order to become incentive eligible for 2014 PQRS, avoid 2016 adjustment, and satisfy the Clinical Quality Measure (CQM) component of the EHR Incentive Program. Refer PQRS guidelines by CMS to check one time reporting options available to individual Eligible Professional and Group of 2 or more Eligible Professionals.

To Report once and get qualified for PQRS and CQM incentive program, EP has to report at

least 9 of the CQM out of 3 strategic National Quality Domain for entire year of 2014. EP will need IACS account to upload data files extracted from EHR CQM Reports. EPs will also have to attest for CQM at time of attestation using same report.

To Report individual for PQRS and CQM, EP will have to follow CQM reporting for the same

90 day period of Meaningful Use and use data at time of attestation. For PQRS, EP can submit data via claim or qualified registry.


https://www.qualitynet.org/portal/server.pt/community/pqri_home/212

PQRS How to Report once or individual for 2014 Medicare

Quality Programs Reporting (PQRS & CQM)?


Eligible Professionals (EPs) have a choice to report one time during the 2014 program year in order to become incentive eligible for 2014 PQRS, avoid 2016 adjustment, and satisfy the Clinical Quality Measure (CQM) component of the EHR Incentive Program. Refer PQRS guidelines by CMS to check one time reporting options available to individual Eligible Professional and Group of 2 or more Eligible Professionals.

To Report once and get qualified for PQRS and CQM incentive program, EP has to report at

least 9 of the CQM out of 3 strategic National Quality Domain for entire year of 2014. EP will need IACS account to upload data files extracted from EHR CQM Reports. EPs will also have to attest for CQM at time of attestation using same report.

To Report individual for PQRS and CQM, EP will have to follow CQM reporting for the same

90 day period of Meaningful Use and use data at time of attestation. For PQRS, EP can submit data via claim or qualified registry.


https://www.qualitynet.org/portal/server.pt/community/pqri_home/212

PQRS: Get Started in 7 Steps


1. Determine if you are Eligible to report PQRS OR CQM

2. Determine Reporting method. If you want to report PQRS and CQM individually or once. If you want to report PQRS individual then how you will report; via Claim based or Registry Based.

3. If the chosen method of the report is qualified registry based, determine which measure reporting option (Individual or Group) best fits your practice. If the chosen method of the report is claim based then you will be able to report only individual measures and not measure groups.

4. Identify NQS Domain: Eligible Professionals may choose at least nine individual measures across three NQS domains as following; * Patient Safety * Person and Caregiver-Centered Experience and outcomes * Communication and Care Coordination * Effective Clinical Care * Community/ Population Health * Efficiency and Cost Reduction

5. Choose Measures: Refer 2014 Measures List and Implementation Guide. 2014 PQRS Individual Claims OR Registry Measure specification supporting documentation. 2014 Group Measures and Implementation Guide

6. Report Measures: For earning incentive and avoiding penalty, Total 9 individual measures out of 3 strategic national quality domain must be submitted for 50% of Medicare Part B and Railroad Medicare claims from Jan 1, 2014 to Dec 31, 2014. Just to avoid penalty, Report at least 3 measures covering 1 NQS domain for at least 50% of the EP's medicare part B FFS Patients satisfactorily.

7. Verify your reporting: If you have submitted via claim, check EOB for N365 denial code

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_PQRS_MeasuresList_ImplementationGuide_12132013.zip

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_PQRS_IndClaimsRegistry_MeasureSpecs_SupportingDocs_12132013.zip

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_PQRS_MeasuresGroupSpecs_ReleaseNotes_SupportingDocs_12132013.zip

PQRS Selecting Common CQM & PQRS


Is Certified PQRS CMS ID NQF Domain Title

Yes 374 50 NA Care Coordination Closing the referral loop: receipt of specialist report


Yes 65 154 69 Efficient Use of Healthcare Resources Appropriate Treatment for Children with Upper Respiratory Infection

Yes 66 146 2 Efficient Use of Healthcare Resources Appropriate Testing for Children with Pharyngitis

Yes 312 166 52 Efficient Use of Healthcare Resources Use of Imaging Studies for Low Back Pain

No 102 129 389 Efficient Use of Healthcare Resources Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients


Yes 143 157 384 Patient and Family Engagement Oncology: Medical and Radiation – Pain Intensity Quantified

Yes 377 90 NA Patient and Family Engagement Functional Status Assessment for Complex Chronic Conditions

No 375 66 NA Patient and Family Engagement Functional status assessment for knee replacement

No 376 56 NA Patient and Family Engagement Functional status assessment for hip replacement



Is Certified PQRS CMS ID NQF Domain Title Yes 130 68 419 Patient Safety Documentation of Current Medications in the Medical Record

Yes 380 179 NA Patient Safety ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range Yes 238 156 22 Patient Safety Use of High-Risk Medications in the Elderly No 318 139 101 Patient Safety Falls: Screening for Future Fall Risk

No 192 132 564 Patient Safety Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures

No 382 177 1365 Patient Safety Child and Adolescent Major Depressive


Yes 134 2 418 Population/ Public Health Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Yes 226 138 28 Population/ Public Health Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Yes 310 153 33 Population/ Public Health Chlamydia Screening for Women Yes 240 117 38 Population/ Public Health Childhood Immunization Status Yes 110 147 41 Population/ Public Health Preventative Care and Screening: Influenza Immunization

Yes 128 69 421 Population/ Public Health Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up No 372 82 1401 Population/ Public Health Maternal depression screening

No 317 22 NA Population/ Public Health Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Yes 239 155 24 Population/ Public Health Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents




Yes 366 136 108 Clinical Process/ Effectiveness ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication

Yes 378 75 NA Clinical Process/ Effectiveness Children Who Have Dental Decay or Cavities

Yes 236 165 18 Clinical Process/ Effectiveness Controlling High Blood Pressure

Yes 311 126 36 Clinical Process/ Effectiveness Use of Appropriate Medications for Asthma

Yes 163 123 56 Clinical Process/ Effectiveness Diabetes: Foot Exam

Yes 1 122 59 Clinical Process/ Effectiveness Diabetes: Hemoglobin A1c Poor Control

Yes 2 163 64 Clinical Process/ Effectiveness Diabetes: Low Density Lipoprotein (LDL) Management

Yes 7 145 70 Clinical Process/ Effectiveness Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)

Yes 5 135 81 Clinical Process/ Effectiveness Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Yes 8 144 83 Clinical Process/ Effectiveness Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Yes 117 131 55 Clinical Process/ Effectiveness Diabetes: Eye Exam

Yes 316 64 NA Clinical Process/ Effectiveness Preventive Care and Screening: Risk-Stratified Cholesterol - Fasting Low Density Lipoprotein (LDL-C)

Yes 309 124 32 Clinical Process/ Effectiveness Cervical Cancer Screening

Yes 112 125 31 Clinical Process/ Effectiveness Breast Cancer Screening

Yes 111 127 43 Clinical Process/ Effectiveness Pneumonia Vaccination Status for Older Adults

Yes 113 130 34 Clinical Process/ Effectiveness Colorectal Cancer Screening

Yes 365 148 60 Clinical Process/ Effectiveness Hemoglobin A1c Test for Pediatric Patients

Yes 204 164 68 Clinical Process/ Effectiveness Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Yes 119 134 62 Clinical Process/ Effectiveness Diabetes: Urine Protein Screening

Yes 371 160 712 Clinical Process/ Effectiveness Depression Utilization of the PHQ-9 Tool




No 305 137 4 Clinical Process/ Effectiveness Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

No 241 182 75 Clinical Process/ Effectiveness Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

No 12 143 86 Clinical Process/ Effectiveness Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

No 18 167 88 Clinical Process/ Effectiveness Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

No 19 142 89 Clinical Process/ Effectiveness Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

No 107 161 104 Clinical Process/ Effectiveness Major Depressive Disorder (MDD): Suicide Risk Assessment

No 9 128 105 Clinical Process/ Effectiveness Anti-depressant Medication Management

No 367 169 110 Clinical Process/ Effectiveness Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

No 72 141 385 Clinical Process/ Effectiveness Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients

No 71 140 387 Clinical Process/ Effectiveness Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

No 368 62 403 Clinical Process/ Effectiveness HIV/AIDS: Medical Visit

No 160 52 405 Clinical Process/ Effectiveness HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis

No 381 77 407 Clinical Process/ Effectiveness HIV/AIDS: RNA control for Patients with HIV

No 191 133 565 Clinical Process/ Effectiveness Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery

No 369 158 608 Clinical Process/ Effectiveness Pregnant women that had HBsAg testing

No 370 159 710 Clinical Process/ Effectiveness Depression Remission at Twelve Months

No 379 74 NA Clinical Process/ Effectiveness Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists

No 316 61 NA Clinical Process/ Effectiveness Preventive Care and Screening: Cholesterol – Fasting Low Density Lipoprotein (LDL-C) Test Performed

No 281 149 NA Clinical Process/ Effectiveness Dementia: Cognitive Assessment

No 373 65 NA Clinical Process/ Effectiveness Hypertension: Improvement in blood pressure

PQRS Configuring Clinical Decision Support Rules


PQRS Alert Display and Necessary Actions


HELP US TO HELP YOU!


Work with us for best implementation of patient experience and clinical workflow

Select Domain and PQRS/ CQM Measures Get Alerts Configuration Find out how to achieve performance for measure Work with us for automatic submission of PQRS codes to claim instead of punching codes

manually in claim to meet PQRS/ CQM requirements

Questions & Answers

?

Thank You!


Webinar 1 - 2014 Requirements Overivew and PQRS_20140328

Documents