Industry Insights

CMS Releases the 2015 Quality Program Reports

October 2016
Authors:  Zach Remmich

Zach Remmich

Managing Consultant

Consulting

201 N. Illinois Street, Suite 700
P.O. Box 44998
Indianapolis, IN 46244-0998 (46204)

Indianapolis
317.383.4000

 & Sarah Bixby

Sarah Bixby

Consultant

Consulting

201 N. Illinois Street, Suite 700
P.O. Box 44998
Indianapolis, IN 46244-0998 (46204)

Indianapolis
317.383.4000

The Centers for Medicare & Medicaid Services (CMS) announced on September 27, 2016, the release of the 2015 Annual Quality and Resource Use Reports (QRURs) and Physician Quality Reporting System (PQRS) feedback reports. The reports provide results on 2015 PQRS and Value-Based Payment Modifier (VBPM) programs for practices, including bonus and penalty amounts affecting Medicare Part B reimbursement starting in 2017. We recommend downloading the 2015 Annual QRUR and Supplemental QRUR as soon as possible to review for accuracy, and if necessary, file an informal review with the CMS.

In addition, these reports can help your practice prepare for the first performance year of the Merit-Based Incentive Payment System (MIPS) within the proposed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, the performance of eligible clinician and group practices on quality, resource use, advancing care information and clinical practice improvement activities will be measured and compared against peers nationally.

The MIPS quality and resource use components share similar performance and reporting characteristics with the current PQRS and VBPM programs. Practices’ QRURs and supplemental tables contain quality and cost information that can help them assess potential MIPS performance. We recommend practices use this information to identify improvement opportunities that can be incorporated into an overall quality and process improvement plan.

To access these reports, organizations must have an active Enterprise Identity Management (EIDM) account. We recommend that organization leadership verify their accounts are still active or create a new account to avoid delays in retrieving the quality reporting feedback.

These are a few important items to note when accessing an organization’s quality reports:

  • Check the organization’s groups, e.g., quality team, to identify who may already have access to these reports
  • Requesting a user role is necessary when signing up for a new EIDM account and seeking access to an organization’s reports. These are brief overviews of the four user roles:
    • Security official role:  register a group in Group Practice Reporting Option (GPRO), obtain quality and feedback reports and submit review requests and approve requests for the “group representative” role on behalf of a group practice—there must be at least one security official role per Tax Identification Number (TIN)
    • Group representative role:  register a group in GPRO, obtain quality and feedback reports and submit review requests on behalf of a group practice
    • Individual practitioner role:  obtain quality and feedback reports, submit review requests and approve requests for the “individual practitioner representative” role on behalf of a solo practitioner—there must be at least one individual practitioner role per TIN
    • Individual practitioner representative role:  obtain quality and feedback reports and submit review requests on behalf of a solo practitioner

To find out if your organization is already registered in the EIDM and the security official or individual practitioner, contact the QualityNet Help Desk at 866-288-8912 or Qnetsupport@hcqis.org and provide the organization or solo practitioner TIN and the practice’s name.

How-to guides can be found by accessing the CMS website, How to Obtain a QRUR.

If you would like information or assistance on program requirements and proposed MACRA compliance, contact your BKD advisor or view the recently conducted webinar, MACRA:  Applications & Implications.

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