PQRS Individual Measures Data Entry Guide

Transcription

1 PQRS Individual Measures Data Entry Guide The deadline t submit PQRS data t New Jersey Innvatin Institute fr prgram year 2016 is March 10 th, 2017

2 Purpse f this Guide This guide prvides simple, step-by-step instructins t help Eligible Prfessinals (EPs) satisfy Physician Quality Reprting System (PQRS) requirements fr the 2016 prgram year using NJII s Qualified PQRS registry. This guide is intended fr EPs wh are reprting using a Measures Grup. If yu are reprting using Individual Measures, please see the PQRS Individual Measure Data Entry Guide. Cntents Overview Individual Measures PQRS Requirements Hw t Get Started with NJII s Qualified Registry Step-by-Step Data Entry Guide Lg In Prepare Yur PQRS Data Enter Yur Data Review Yur PQRS Summary Cmplete Yur Final Submissin

3 Overview Individual Measures With NJII yu can mix and match frm 198 Individual Measures t reprt n the best measures that represent the prvider the best, allwing mre flexibility fr measure selectin. Individual Measures must be reprted fr Medicare Part B Fee-Fr-Service (FFS) patients seen by an Eligible Prfessinal (EP) thrughut the full calendar year. EPs must reprt n at least 9 measures cvering at least 3 Natinal Quality Strategy (NQS) dmains fr >50% f Medicare Part B FFS patients eligible fr each measure. The Measures Applicability Validatin (MAV) Reprting a Measures Grup is a simple ptin fr many reasns: T avid the -2% penalty in 2017, EPs must: Reprt at least 9 individual measures acrss at least 3 dmains Reprt n at least 50% f eligible Medicare Part B FFS patients r encunters fr each measure Reprt ne (1) crss-cutting measure if they had at least ne (1) face-t-face encunter with a Medicare fee-fr-service patient during 2016 Fr each measure, reprt a perfrmance f greater than 0% (r less than 100% fr inverse measures, where a lwer perfrmance rate indicates better perfrmance) List f 2016 Crss Cutting Measures: #1 Diabetes: Hemglbin A1c Pr Cntrl #46 Medicatin Recnciliatin Pst Discharge #47 Care Plan #110 Preventive Care and Screening: Influenza Immunizatin #111 Pneumnia Vaccinatin Status fr Older Adults #112 Breast Cancer Screening #128 Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw-Up Plan #130 Dcumentatin f Current Medicatins in the Medical Recrd #131 Pain Assessment and Fllw Up #134 Preventive Care and Screening: Screening fr Clinical Depressin and Fllw-Up Plan #154 Falls: Risk Assessment #155 Falls: Plan f Care #182 Functinal Outcme Assessment #226 Preventive Care and Screening: Tbacc Use: Screening and Cessatin Interventin #236 Cntrlling High Bld Pressure #317 Preventive Care and Screening: Screening fr High Bld Pressure and Fllw-Up Dcumented #400 One-Time Screening fr Hepatitis C Virus (HCV) fr Patients at Risk: #402 Tbacc Use and Help with Quitting Amng Adlescents #431 Preventive Care and Screening: Unhealthy Alchl Use: Screening & Brief Cunseling

4 PQRS Requirements T satisfy prgram year 2016 PQRS requirements fr reprting Individual Measures and avid a 2% payment adjustment in 2018: 1. Chse 9 Measures Grup acrss at least 3 f the NQS Dmains that is relevant t yur EP. Review the perfrmance numeratr criteria fr each measure t make sure the measures are relevant t yur scpe f practice. TIP: CMS specificatins fr each Measures can be fund n the NJII Prtal. On the Getting Started Tab, click the Reprting Individual Measures sub tab, and then click n the link fr the Specificatin Manual. 2. Cllect the ttal number f Eligible Instances per Individual Measure the prvider is reprting n. Make sure the patients are Medicare FFS patients (includes Medicare Secndary and Railrad Medicare). T identify eligible patients, search fr claims with dates f service during 2015 that have specific patient denminatr criteria such as diagnsis, age, and prcedure (CPT) cde. Mst electrnic billing sftware and/r vendrs will be able t generate a reprt f eligible patients using these criteria. TIP: Use the CMS Specificatin Sheets n the NJII Prtal t review denminatr criteria. On the Getting Started Tab, click the Reprting Individual Measures sub tab, and then click n the link fr the Specificatin Manual. 3. Cllect data fr each individual measure the prvider is reprting. The clinical data related t the measures can be dcumented in either paper, electrnic charts, r reprts but prf that the reprted clinical actin was perfrmed must be clearly dcumented in the patient s recrds. Make sure that yu can supply this supprting dcumentatin t CMS in the event f an audit. Cllect the fllwing summary r aggregate data required t reprt individual measures: # f Eligible Instances # f Eligible Instances where perfrmance is met # f Eligible Instances where perfrmance is excluded # f Eligible Instances where perfrmance is nt met 4. Submit data t NJII s Qualified PQRS Registry by March 10, Hw t Get Started with NJII s Qualified Registry If yu have nt yet registered fr prgram year 2016, please cntact a NJII PQRS Specialist at r pqrs@njii.cm.

5 Step-by-Step Data Entry Guide Step 1: Lg In Users will receive their username and passwrd (in tw separate s) immediately after payment has been received by NJII. NOTE: If yu have previusly used NJII s PQRS Registry (Frmerly NJ-HITEC) fr reprting, yu will receive a new username and passwrd fr 2016 Reprting Visit in a new brwser windw Lg in with yur mynjii Prtal username and passwrd If yu frgt yur passwrd r yur passwrd is incrrect, click n Frgt Passwrd t reset it Yu can skip t Step 3 if yu have already cllected yur patient data Step 2: Prepare Yur PQRS Data Click Reprting Individual Measures in the tp menu t view 2016 PQRS reprting requirements and dwnlad CMS Individual Measures Specificatin Sheets. Use the Reprting Criteria n CMS Individual Measures Specificatins Manual t cllect data fr at least 9 measures acrss 3 Natinal Quality Strategy (NQS) Dmains. Cllect the fllwing summary r aggregate data required t reprt Individual Measures: # f Eligible Instances # f Eligible Instances where perfrmance is met # f Eligible Instances where perfrmance is excluded # f Eligible Instances where perfrmance is nt met

6 Step 3: Enter Yur Data Step 3A: Select Individual Measures Click the Data Entry tab Select a prvider by clicking n the crrespnding rw in the table displayed n the screen Verify that the prvider s NPI and Tax ID are crrect Click under the Reprting Type clumn A Reprting Type pp-up windw will appear Select Individual Measures and click Save Scrll t the bttm f the page and click Enter Data in the lwer right hand crner

7 Step 3B: Select Yur Reprting Gal and Measures T begin selecting yur Individual Measures answer the 2 questins belw: Has this prvider had at least 1 face-t-face encunter with a Medicare patient during 2016? D at least 9 measures acrss 3 NQS dmains apply t this prvider? Click Add Measures in the tp right crner T add a Measure t yur Measures List click check bx t the left f the Measure # T add r remve a Favrite measure, click the star in the Favrites clumn Once yu have all yur Measures Selected, Click Save at the tp f the screen Fr inverse measures, a lwer perfrmance % is better (Inverse Measures are indicated by Hver ver clumn header title fr mre details Step 3C: Reprt Yur Measures Enter in the data cllected fr each measure # f Eligible Instances # f Eligible Instances where perfrmance is met # f Eligible Instances where perfrmance is excluded # f Eligible Instances where perfrmance is nt met

8 Step 4: Review Yur PQRS Data On the Data Entry screen: Review yur PQRS Measures List t make sure all applicable measures are reprted. If a measure is incmplete enter in the missing fields Click Submit in the tp right t prceed t the final submissin screen The PQRS Measures List breaks dwn the reprting rate and perfrmance rate based n CMS guidelines. The reprting rate is the percentage f eligible patients fr whm yu selected a perfrmance. The perfrmance rate is the number f eligible patients that meet the measure criteria. Yu need t have a 50% reprting rate t meet the PQRS requirements, and shuld aim fr a high-perfrmance rate t indicate better quality care. The items n the Submissin Checklist (at the bttm f the screen) represent the minimum requirements t avid the 2018 PQRS payment adjustment f -2%. Yu must meet all gals t successfully submit yur PQRS data t NJII s Registry. The Submit buttn will nly be active when all criteria in the Submissin Checklist are met.

9 Step 5: Cmplete Yur Final Submissin Duble-check yur NPI and Tax ID! If yur NPI and/r Tax ID is incrrect, DO NOT PROCEED with yur submissin. Call NJII at t update yur NPI and/r Tax ID infrmatin. Check the bx next t each statement t agree Cmplete the Submitter Validatin fields Once yu have duble-checked yur infrmatin, click Submit The deadline t submit PQRS data t New Jersey Innvatin Institute fr prgram year 2016 is March 10 th, 2017