Webinar 6 : Detailed Overview of PQRS and CQM 2014 | DigiDMS.com

Webinar 6:Detailed Overview of PQRS &

CQM 2014using DigiDMS EHR 2014 Edition

Tuesday, April 14, 2014 at 3:30 PM ESTWednesday, April 15, 2014 at 4:30 PM EST

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

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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

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�

PQRSHow 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.

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

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

Requirements for Implementing MU in 2014


1. Select CQM for 2014, Select PQRS for 2014. You can choose common CQM and PQRS to meet both incentive program requirements.• Choose 9 OR more measures from at least 3 domains• Even If you are demonstrating for MU Stage 1, You will have to

selct Stage 2 CQMs2. Mark as “Implemented and Active” in DigiDMS Patient Screening

Module. [Optional ]3. Verify Alert [Optional]4. Take appropriate actions5. Review PQRS codes suggested by system. 6. Verify CQM and PQRS Performance7. Generate QRDA Report for CQM Attestation [Optional]

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Step 1: Select CQM and PQRS

EHR * PM * Patient Portal * Direct Messaging * Secure Healthcare Messaging6

Step 1: Select Common CQM & PQRS


Certified PQRS CMS ID NQF Domain TitleYes 1 122 59 C,R Clinical Process/ Effectiveness Diabetes: Hemoglobin A1c Poor ControlYes 2 163 64 C,R Clinical Process/ Effectiveness Diabetes: Low Density Lipoprotein (LDL) Management

Yes 5 135 81 C,R Clinical Process/ Effectiveness

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Yes 111 127 43 C,R Clinical Process/ Effectiveness Pneumonia Vaccination Status for Older AdultsYes 112 125 31 C,R Clinical Process/ Effectiveness Breast Cancer ScreeningYes 113 130 34 C,R Clinical Process/ Effectiveness Colorectal Cancer ScreeningYes 117 131 55 C,R Clinical Process/ Effectiveness Diabetes: Eye ExamYes 119 134 62 C,R Clinical Process/ Effectiveness Diabetes: Urine Protein ScreeningYes 163 123 56 C,R Clinical Process/ Effectiveness Diabetes: Foot Exam

Yes 204 164 68 C,R Clinical Process/ EffectivenessIschemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Yes 236 165 18 C,R Clinical Process/ Effectiveness Controlling High Blood PressureYes 130 68 419 C,R Patient Safety Documentation of Current Medications in the Medical RecordYes 110 147 41 C,R Population/ Public Health Preventative Care and Screening: Influenza Immunization

Yes 128 69 421 C,R Population/ Public HealthPreventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

Yes 134 2 418 C,R Population/ Public HealthPreventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Yes 226 138 28 C,R Population/ Public HealthPreventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Choose 9 OR more measures from at least 3 domains

Step 1: Option


1. Select CQM [for 90 Days of Your Meaningful Use Demonstration]

2. Select PQRS [for Entire Year]

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Choose CQM [64 CQM]

Choose PQRS [284 Measures]

Choose 9 OR more measures from at least 3 domains

Report Separately for CQM at time of MU Attestation & PQRS via Claims

https://www.cubby.com/pli/CQM_PQRS_ALIGNMENT_ALL64_updated-2.xlsx/_dfe0c21be229412c9c5c50e73aeaec82�

https://www.cubby.com/pli/2014_PQRS_IndividualMeasureSpecManual_12132013.pdf/_d4c7888f9d0c47c49f3f4b84ecd1c23d�

Step 2: Activate Alerts (Optional)


DigiDMS EHR Patient Screening Module


Step 3: Verify Alerts (Optional)DigiDMS EHR Patient Chart Alerts


Step 4: Take Appropriate ActionsPQRS CMS IDNQF Domain Title

226 138 28 C,R Population/ Public HealthPreventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user

Numerator: If Patient is a smokerOrder 99406 : CounsellingOROrder Medication


Step 5: Review PQRS Code suggested by EHR)


Step 5: Review PQRS Code suggested by EHR)


Step 6: Verify CQM Performance


Step 7: Generate QRDA Report for submission[ Optional ]


CQM Explanation – CQM 165

Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

Numerator: Systolic BP< 140 Diastolic BP<90

PQRS

CMS IDNQF Domain Title

236 16518 C,RClinical Process/ Effectiveness Controlling High Blood Pressure



Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Numerator: HBA1C > 9.0%

PQRS


1 12259 C,RClinical Process/ Effectiveness

Diabetes: Hemoglobin A1c Poor Control



Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.

Numerator: HBA1C > 9.0%

PQRS


112 12531 C,RClinical Process/ Effectiveness Breast Cancer Screening

Please Refer DigiDMS HER version 14.0.10 OR Refer document links provided in earlier slide to refer details of other CQMs


CQM Explanation

Please Refer DigiDMS EHR version 14.0.10 OR

Refer document links provided in earlier slide to refer details of other CQMs


Questions & Answers

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Thank You!


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Webinar 6 : Detailed Overview of PQRS and CQM 2014 | DigiDMS.com

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