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News & Press: Clinical Alerts

Medicare Providers Take Note: Report PQRS Measures in 2013

Friday, March 1, 2013  
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The Centers for Medicare and Medicaid Services (CMS) has announced the Physician Quality Reporting System (PQRS) will subject clinical social workers and other health care professionals who are Medicare providers to a 1.5 percent penalty fee in 2015 if they do not use measures when performing services to Medicare patients during the year of 2013. PQRS is a program promoting the reporting of measures to determine quality services. To avoid this penalty in 2015, clinical social workers must use clinical measures developed by PQRS in 2013. Mirean Coleman, MSW, LICSW, CT, Senior Practice Associate at NASW National, has written an excellent "Practice Perspective” on Reporting PQRS Measures for Medicare in 2013 (see url/link below).

I have excerpted some preliminary information in the document.

"NASW encourages clinical social workers who are Medicare providers to participate in the 2013 Physician Quality Reporting System (PQRS). Doing so not only increases practice revenue by .5 percent, but helps clinical social workers avoid a 1.5 percent penalty in 2015 for not using measures in 2013.

Although participation in PQRS for 2013 is optional for clinical social workers and other Medicare providers, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made PQRS a permanent program. Medicare is converting to a value based purchasing system. Beginning in 2013, clinical social workers and other providers will be subject to a penalty when they do not report performance measures. 2014 will be the last year clinical social workers and other Medicare providers will receive a bonus incentive for participating in PQRS. Because PQRS varies each calendar year, clinical social workers must become familiar with the rules and regulations of this program annually.

PQRS identifies specific measures that may be used by clinical social workers in independent private practice to improve the quality of care provided to Medicare beneficiaries. These measures are standards of care based on evidence-based practices. For 2013, there are 259 available performance measures. Clinical social workers have access to 11 individual measures and no measure groups. Claims reporting, using the CMS-1500 Form appears to be the best method of reporting measures for clinical social workers who are independent practitioners in solo or group practice.”

The new practice perspective, Reporting PQRS Measures for Medicare in 2013: is packed with much of the information you need to know on PQRS. It includes two very important links to CMS websites you should also review. If you are in private practice and have Medicare patients, I STRONGLY recommend you read the NASW Practice Perspective, and begin reporting on the PQRS measures no later than July, 2013.

Last, PQRS probably will be confusing for many social workers for the first couple of billing cycles. However, it will become easier each time you do it.

Please let me know if NASW’s Practice Perspective article is helpful.

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