Health Law News From Arnold & Porter

Health Law News From Arnold & Porter

December 19, 2012
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Small group practices may begin reporting quality and e-prescribing measures as group in 2013

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From international law firm Arnold & Porter LLP comes a timely column that provides views on current regulatory and legislative topics that weigh on the minds of today’s physicians and health care executives.

Starting Jan. 1, small group practices will have an alternative way to participate in the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Programs. In the past, group practice reporting options (GPRO) were limited to large practices, consisting of at least 25 eligible professionals (EPs).

Catherine Brandon

Under the new rule, a group practice has the option to report PQRS quality measures and eRx prescribing measures for Medicare beneficiaries as a group if that group consists of as few as two EPs (as determined by their individual National Provider Identifier), who have reassigned their Medicare billing rights to the group’s tax identification number. Reporting as an individual requires EPs to keep track of their individual reporting requirements, whereas group reporting allows EPs’ billing and reporting staff to report one set of quality and e-prescribing measures data on behalf of all EPs within a group practice.

Evaluating whether group reporting makes sense for your practice is particularly important as these incentive programs are soon becoming “mandatory” because EPs and groups will face increasing downward payment adjustments to their total Medicare Part B payments, with no prospect of bonuses, if they do not participate in these programs beginning in 2013. Because the 2013 reporting year will be the basis for determining payment adjustments under PQRS in 2015, physicians will face a 1.5% reduction in Medicare Part B payments in 2015 if they do not successfully report PQRS quality measures in 2013. EPs also will forgo the 2014 PQRS bonus if they do not successfully report in 2013.

In 2016, the payment adjustment will rise to 2.0%, based on reporting for 2014. With regard to the eRx Incentive Programs, the G-codes reported in 2013 will be the basis for 2013 eRx incentive payments as well as avoiding the 2% 2014 eRx payment adjustment.

To participate in PQRS GPRO and eRx GPRO, groups must self-nominate by submitting a PQRS or eRx self-nomination form through a CMS-developed website from now through Jan. 31, 2013. For PQRS only, a second group self-nomination will be open between summer 2013 and Oct. 15, 2013. Unlike previous years, group practices are not required to participate in PQRS GPRO to participate in eRx GPRO.

There are several reporting mechanisms available for group practices. For PQRS, groups can report using the GPRO web interface, a qualified registry, or administrative claims. Medicare expects that the new administrative claims option for PQRS will be available only for the 2015 PQRS adjustment. EPs or group practices that want to take advantage of the administrative claims option must complete this election by the Oct. 15, 2013 deadline. Beginning in 2014, EHR-based reporting mechanisms also will be available to groups participating in the PQRS GPRO. For the eRx GPRO, groups may submit eRx events through a qualified registry, administrative claims, or electronic health records.

Generally, if an EP’s practice chooses the GPRO, an individual EP will not have the option of opting out in order to receive an individual incentive payment or payment adjustment. The only exception is when an EP’s practice reports PQRS measures via the Adjustment Claims option. If the group chooses this method, an individual EP can choose to opt out of group reporting and receive an individual payment adjustment for PQRS. There is no opt out option in the eRx Incentive Program: if a practice decides to report as a group; all EPs must report through that method.

Given the varying requirements for individual vs. group reporting options, group practices should consider the administrative burdens of each approach, as well as the history of their past reporting efforts, to determine which option and which reporting mechanism makes the most sense.

Catherine Brandon, JD, can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-6823; email: Catherine.Brandon@aporter.com.

Lauren Miller can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-5915; email: Lauren.Miller@aporter.com. Miller is not currently admitted to the practice of law.