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Clinical Alert: Reporting Requirements for PQRS 2015

Wednesday, March 4, 2015  
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NASW Clinical Alert Winter 2015

Reporting Requirements for PQRS 2015 for Individual Measures Used by Clinical Social Workers

Mirean Coleman, LICSW, CT – NASW Senior Practice Associate,

Since 2007, clinical social workers have been eligible to report Physician Quality Reporting System (PQRS) under the Tax Relief and Health Care Act of 2006. PQRS identifies individual measures that may be used by clinical social workers in private practice to improve the quality of care provided to Medicare beneficiaries.

From 2007- 2014, clinical social workers who were Medicare providers received an annual bonus incentive payment when successfully reporting PQRS. A positive payment adjustment for successfully reporting PQRS 2015 will be based on the value-based modifier (VM) which will be applied to the reimbursement of clinical social workers in 2017 based on the payment year 2015. The value-based modifier is a differential payment provided to Medicare providers based on the quality of care furnished compared to cost during the performance period. When PQRS is successfully reported in 2015, the value-based modifier may create a positive payment adjustment in 2017 whereas lack of PQRS reporting may create an additional negative payment adjustment in 2017. Additional information regarding the value-based modifier is available online at the following link: click here. NASW encourages its members to report PQRS to avoid reductions in Medicare reimbursement in 2017.

PQRS measures are developed through a variety of resources including the Centers for Medicare and Medicaid Services (CMS), the American Medical Association Physician Consortium for Performance Improvement (AMA/PCPI), the National Quality Forum (NQF), and the National Committee on Quality Assurance (NCQA). NASW has participated in the development of PQRS measures and is advocating for additional performance measures for clinical social workers.

Because PQRS varies each calendar year, clinical social workers must become familiar with the rules and regulations of this program annually.

For clinical social workers, PQRS is used when providing psychotherapy services to Medicare beneficiaries who are covered by traditional Medicare fee for services (FFS), Railroad Retirement Board, and Medicare Secondary Payer. Not included in PQRS are Medicare Advantage Plans and Federally Qualified Health Centers.

NASW Members:

For full details and to take part in NASW National’s "An Hour With Private Practice: Questions and Answers - Getting Started With Medicare PQRS in 2015" call, click the button below.

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