Open Icon Key

PQRS Downward Adjustments

in Medicare
By Team KMCU

PQRS Downward Adjustments

PQRS Downward AdjustmentsIs your money in danger of flying out the window??? If you haven’t taken time to review your 2016 PQRS and QRUR reports, it could be doing just that!

The Physician Quality Reporting System (PQRS) is voluntary and was designed to improve the quality of healthcare. The program applies a downward payment adjustment to practices that do not satisfactorily report quality measures for covered Medicare Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Pay).

The Annual Quality and Resource Use Reports (QRUR), although less well-known to chiropractors at this time, is a report card, of sorts, for doctors that participate in Medicare. It provides feedback on your performance with the Value-Based Modifier (VBM), and the care you are providing to your Medicare patients. The VBM was part of the Affordable Care Act and addresses the pay-for-performance program. DCs that did not participate in the 2016 PQRS program are going to see an automatic 2% deduction in their VBM over and above the 2% deduction they’ll have from not successfully reporting PQRS. DCs that did participate may see no adjustment, a 2% penalty, or a payment incentive of as much as 2% depending on the results of their reporting. With Zero (0) being the average, if your VBM rating is between -1 and +1, then you have a neutral adjustment. If you fall below -1, you would see a negative adjustment, with performance above +1 bringing payment incentives.

For example, if you reported successfully for PQRS in 2016, you will avoid the negative 2% adjustment in 2018. In addition, based on your PQRS behaviors with patient care which determine your VBM rating, if you scored 0 – which is average – you would not see a reduction for VBM either, essentially keeping 4% of your reimbursements.

If you already have an Enterprise Identify Data Management (EIDM) account, use this link for instructions on locating your reports.

If you do not have an EIDM account yet or need further details on how to access the 2016 Annual QRURs, please visit How to Obtain a QRUR.

These reports, released in September 2017, are subject to a 2-year lag, so the information you provided in 2016 won’t affect your reimbursement until 2018. If that’s the case, why do you need to worry about it now? From now until December 1, 2017 you can access these reports to confirm the information is accurate and request a review if you disagree with the results. Depending on your volume of Medicare patients, you may need to adjust your budget accordingly.

For additional information, check the following sites:

Investing a few minutes of your time could help you keep that money in your wallet. It’s all up to you!