How a Physician Quality Reporting System Works With Ingenious Med
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PQRS – How PQRS Works Within Ingenious Med

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HOW PQRS WORKS WITHIN INGENIOUS MED

How does the PQRS module work within Ingenious Med’s applications?

• Upon entry of an encounter that fits the reporting requirements of a quality measure the provider’s group has chosen to report (what we typically refer to as a triggering bill), a questionnaire will pop up for the physician to address any measures that apply.

o The physician has the option to answer immediately or defer until later.
o Every bill created for that patient by a provider who had not yet answered their questionnaire will generate the same pop-up reminder until the measure question is answered
*The user can also check the “don’t ask again” box if their final answer is “unknown” and they don’t want to see continued pop-up reminders.

o Only the physician recorded as owning the trigger bill, PAs with permission to bill for the owner of the triggering bill, and administrator user types will have the ability to view and answer the question for that physician’s trigger.
o If the group does not participate in IM’s PQRS registry service, answers for a measure can be changed only until the triggering bill has been sent for payment. If the groups has the PQRS registry service activated, answers to PQRS questions can be changed at any time until the data is locked down for submission at the end of the year.

• The IM Quality tab coloration will reflect the PQRS status, with the least desirable status taking precedence. Mousing over the Quality tab will show the list of applicable measures (with individual color coded status for each instance). Clicking the Quality tab will open the questionnaire to show the questions and the answers given (and will allow editing where applicable).
• As soon as a measure is triggered, an answer is generated by the system. It defaults to “measure action not performed” until/unless the provider gives an explicit answer of their own. If they do not change the default answer, the event will be reported as “measure action not performed” in order to maintain the minimum reporting rate requirements for successful participation. These events will, however, adversely affect the provider’s performance (quality) rating, since “measure action not performed” events reflect poorly on physicians.
• Click here to view the physician quick start guide for a more detailed description with a demonstration video.

What will change for billers when the PQRS module is activated?

Any bill with an unanswered PQRS measure associated with it will appear on the Daily Encounter log with a yellow triangle/exclamation point icon on the left side. This serves as an indication to the biller that, if they mark this bill as sent (and the group does not have the PQRS registry service activated), they are essentially locking in a “measure action not performed” event for that physician’s reporting (since unanswered questions are reported as “not performed” events, and answers cannot be changed after the bills are marked as sent for non-registry groups).

Why might my billing company indicate that reporting opportunities are being missed on measures we have activated within Ingenious Med applications?

Reporting for many PQRS measures only require one reporting event per physician during a single hospital stay by a given patient. If a physician has already reported a measure for a patient, and enters another bill for that patient during the same stay that (taken alone) also matches that measures trigger scenario, the system recognizes that physician’s reporting requirements have already been met and will not require the physician to answer the measure again. In cases where the reporting requirements are based on patient stay, a billing company looking at individual bills on any given day may not realize that physician’s reporting requirement for that patient has already been fulfilled in conjunction with an earlier bill. In cases where measures require answers each and every time a trigger scenario is encountered (even multiple times by the same physician on the same patient), the system will request an answer each time the measure applies.

Will PQRS participation become mandatory in the future?

Once the penalties go into effect, any provider submitting claims to Medicare will be considered to be participating in PQRS by default – they just won’t be participating successfully, unless they also report adequately in relation to PQRS measures that apply to those claims. The imposition of fines and other motivators will likely make active participation in the program a foregone conclusion for the vast majority of organizations.

Are mobile platforms supported in the IM Quality Measures module?

Yes. All current mobile applications offered by Ingenious Med have PQRS capabilities.

Is mid-level billing supported in the IM Quality Measures module?

Yes. Mid-levels who bill under their own NPI can use impower or IM1 to record and report their own PQRS participation. If ownership of a triggering bill is subsequently changed to another provider’s name (e.g., their supervising MD), the PQRS reporting associated with that triggering bill will also transfer to the same provider as well.

Is there a fee for activating the IM Quality Measures module?

No, there is no additional fee associated with activation.

Will PQRS pop-ups appear for all patients, or only Medicare patients?

There is currently no filter in the system to distinguish between Medicare and non-Medicare patients. If the patient meets the target demographics for the measure and an appropriate ICD and/or CPT is entered, the measure will be triggered. Future enhancements may provide a filter for Medicare patients, though many practices may prefer to continue capturing quality of care data for all patients, Medicare and non-Medicare alike. In relation to PQRS reporting requirements, there is no harm in reporting PQRS data for non-Medicare patients and, likewise, there is no penalty for failing to enter PQRS data for patients who are non-Medicare. PQRS registry clients will submit a file obtained from their billing company at the end of the year to identify Medicare patients for registry submission, since registry data must be restricted to only Medicare patients.

How does IM’s quality module facilitate high reporting rates to ensure successful participation?

As soon as a measure is triggered, an answer is generated by the system. It defaults to “measure action not performed” until/unless the provider gives an explicit answer of their own. If they do not change the default answer, the event will be reported as “measure action not performed” in order to maintain the minimum reporting rate requirements for successful participation. These events will, however, adversely affect the provider’s performance (quality) rating, since “measure action not performed” events reflect poorly on physicians.

Will physicians need to know the appropriate choices for CPT II codes and modifiers or report PQRS measures, or remember when specific measures apply?

PQRS questionnaire window will open automatically when a bill is created that requires a quality measure response. The system will ask questions and offer answer choices in plain language, so knowledge of specific CPT II codes or modifiers is never required.

Is date of birth required to activate measures that have an age requirement?

No. Measures that require an age component only need the chronological age. If that value already exists in the impower or IM1 database (either entered directly, or calculated by the system automatically following the entry of a DOB), that value will be used in evaluating the applicability of a measure. If the patient’s age is not available at the time a measure potentially applies, the physician will be prompted to enter the patient’s age.

What will Ingenious Med’s billing interface do with CPT II codes for non-Medicare payers?

Adjustments can be made to the interface prior to activating the IM Quality Measures module so the quality data codes can be filtered before the bills are sent to non-Medicare payers.
What should we do with CPT II codes before sending bills to non-Medicare payers if we do not have an Ingenious Med billing interface?

CPT II codes should be manually stripped from the bills by the billing company before sending to non-Medicare payers to reduce the likelihood of delayed reimbursement or possible rejections for bills accompanied by CPT II codes. Most billing companies are aware of this need and have taken steps to ensure this occurs automatically.

Are there any problems billing partially with Ingenious Med applications and partially outside of them?

All of their billing under a given tax ID should be done within impower or IM1, with a few very specific exceptions:

• If the provider bills entirely through impower or IM1 at one facility with a given tax ID and bills somewhere else (without Ingenious Med applications) under a different Tax ID, that won’t present any problems:

o The provider participation is evaluated by CMS separately under the separate tax IDs, so there is no data “missing” from Ingenious Med’s records in this case.
o The provider could submit through Ingenious Med via claims and registry.

• If the provider bills at two places, one using Ingenious Med applications and one not, but those places share the same Tax ID, things get more complicated:

o IM does not have all of the data necessary to evaluate all reporting and performance for the provider in this case.
o The provider cannot report through Ingenious Med’s registry.
o The provider can certainly attempt to participate through claims. In that scenario, the percentage of billing done using impower or IM1 (versus non-IM billing) and the reliability of claims data stream (downstream of IM) for those reporting events factor into the likelihood of success for their participation. If there is claims-based reporting in effect for the non-IM billing, that would improve the provider’s chances for successful claims-based participation.

Why does the Advance Care Plan (measure #47) questionnaire pop up for more than one physician on the same patient?

This is related to the way the measure is defined by CMS (not by IM). CMS requires that each physician entering a bill that matches the trigger scenario of a measure to also report on that measure. This includes physicians who see the patient after another physician may have already billed the patient and reported an answer for the measure questionnaire. Since participation in PQRS is evaluated by individual NPI, CMS analytics do not recognize another provider’s answer (even for the same patient/measure) as relating to any answers required from other providers. Whenever the system presents a questionnaire to a provider during billing, it indicates CMS is expecting to see a reporting event related to that bill, and failure to report will negatively affect PQRS performance for the provider. In the case of measure #47, each physician does not need to question the patient directly; if there is documentation related to the measure in the chart from a previous encounter, subsequent physicians can answer the questionnaire based on existing documentation.

Why do discharge questions appear on admissions and follow-up bills for some stroke measures?

This is related to the way the measures are defined by CMS (not IM). When CMS removed the consult codes and replaced them with admission codes for standard billing, the measure designers for these three measures (#32 – Discharged on Antithromotic Therapy, #33 – Anticoagulant Therapy Prescribed for Atrial Fribrillation at Discharge, and #36 – Rehabilitation Services Ordered) made the same replacements in the definition of their measures. The measure designers were either unfamiliar with or unconcerned with the typical hospitalist workflow, in which the admitting physician and discharging physician are frequently not the same provider. Since these questions are inappropriate to answer upon admission in many cases, and failure to answer the question results in an action-not-performed reporting event for the physician, provider performance rates are frequently adversely affected by this measure. For this reason, IM recommends strongly against using these 3 measures.

 

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