Medicare PQRS IMPORTANT Changes in Reporting Options
January 1, 2016
In reporting your PQRS Measures, most of you have chosen the claims based reporting option. This has allowed ABI to submit these Measures on your behalf with each Medicare claim we submit. However, as we suspected this would eventually happen (just didn’t expect this quickly), the claims based reporting will no longer be an option for reporting purposes in 2016 for Anesthesia Services/Measures.
American Society of Anesthesiologists (ASA) (http://asahq.org/quality-and-practice-management/quality-improvement/physician-quality-reporting-system/2016-pqrs-faqs – Question #8)
“For the Claims-based Reporting Option – The Centers for Medicare & Medicaid Services (CMS) released the 2016 Physician Fee Schedule rule on October 30, 2015. In the rule, CMS retired PQRS #193 and removed the claims-based reporting option for PQRS #44. In addition, all five anesthesia measures added for the 2016 program were finalized as reportable via registry only. This action has left PQRS #76: Prevention of Central Line Catheter (CVC)-Related Bloodstream Infections as the only reportable anesthesia care measure via the claims-based mechanism for 2016.
For the “traditional” Qualified Registry reporting option, measures for anesthesia care include:
- #44: Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery (Registry ONLY)
- #76: Prevention of Central Line Catheter (CVC)-Related Bloodstream Infections (Claims, Registry)
- #404: Anesthesiology Smoking Abstinence (Registry ONLY)
- #424: Perioperative Temperature Management (Registry ONLY)
- #426: Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post Anesthesia Care Unit (PACU) (Registry ONLY)
- #427: Post-Anesthetic Transfer of Care: Use of Checklist or Protocol for Direct Transfer of Care from Procedure Room to Intensive Care Unit (ICU) (Registry ONLY)
- #430: Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy (Registry (ONLY)
For the AQI/NACOR QCDR reporting mechanism, there are more than nine (9) anesthesia care measures across three (3) NQS domains to choose. Please visit the AQI/NACOR QCDR webpages for additional information and measure details.
Because anesthesiologists practice in a variety of settings and encounter different patient populations, ASA recommends exploring other measures that may apply to your practice.
CMS ultimately determines the measures an EP should report. ASA encourages EPs to contact the CMS QualityNet Help Desk at (866) 288-8912 or via email at firstname.lastname@example.org to ensure they are reporting applicable measures.”
One additional Measure, if fluoroscopy is used and billed, remained unchanged from 2015:
- #145: Radiology: Exposure Time Reported for Procedures Using Fluoroscopy (Claims, Registry)
Because the majority of the Measure options available to anesthesia providers is now Registry only, and the required number of required Measures has remained unchanged, nine (9) Measures over three (3) NQS domains, registry reporting will be required by anesthesia providers for 2016 Reporting to keep from receiving the 2% reduction in payments for 2018.
There are many CMS Qualified Registries available for this reporting option, however, we are including two for your initial research. All Registries will include additional fees and require the acquisition of necessary data in different forms/formats, so we urge you to research each thoroughly prior to making any selections. There may also be additional fees associated with Anesthesia Billing, depending on which Registry you go with, as there may be required additional interface files necessary by us to transfer information to the Registries. Once you have researched and have narrowed down your selection(s) and if information is required through the billing system software (i.e. from ABI), please feel free to contact us to ensure the required data format required by the Registry is obtainable.
ASA (CRNAs will have access to ASA for reporting PQRS):
PQRS Solutions (a division of Mingle Analytics):
For additional general information on PQRS, please visit:
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