1. PI Integrated PQRS Registry
Powered by Alpha II
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Presented By:
Deidre Lawson Ellis – Product Manager, Practice Insight Stacey LaCotti– Implementation and Training, Alpha II

2. AGENDA PQRS – The basics Why PI/Alpha II Registry? Live Demo
Who must participate in PQRS?
Reporting requirements
Measure requirements
Penalties and Audits
Why PI/Alpha II Registry?
Integrated workflow
Automated reporting
Live Demo
Demo of workflow
PQRS Deadlines
Next Steps
Amendment
Enrollment Forms
Kickoff call/UI setup
Q&A
Contact info
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3. KEY POINTS PQRS – Doesn’t have to be hard Instant Feedback
PI and Alpha II have streamlined this process to be as easy as possible with:
Auto Submissions
Direct and Easy User Interface
Instant Feedback
Integrated dashboard
Real-time percentages
Easy on the wallet, Big on Support
Competitive Pricing
Three layers of support
Submitting through a QUALIFIED Registry
Includes ALL measures for Individual and Group reporting!
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4. PQRS – THE BASICS What is PQRS?
PQRS is part of the initiative to move from the fee for service payment model to pay for performance (P4P). Under the P4P model, payments to a physician are linked with the quality of healthcare provided to the patient. It introduces quality and efficiency incentives and works on the model of coordinated care.
The fee for service model, where physicians charge separately for each of the services provided to any patient, has been largely attributed to the increase in medical costs. Having the physicians move away from such a service and linking their payments to provision of quality care will improve the standards of healthcare delivery and serve as a method to reduce costs.
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5. WHO MUST PARTICIPATE
Services paid by MPFS and providers who do not participate in an ACO
Medicare Physicians
Practitioners
Therapists
Doctor of Medicine
Doctor of Osteopathy
Doctor of Podiatric Medicine
Doctor of Optometry
Doctor of Oral Surgery
Doctor of Dental Medicine
Doctor of Chiropractic
Physician Assistant
Nurse Practitioner *
Clinical Nurse Specialist *
Certified Registered Nurse Anesthetist * (and Anesthesiologist Assistant)
Certified Nurse Midwife *
Clinical Social Worker
Clinical Psychologist
Registered Dietician
Nutrition Professional
Audiologist
Physical Therapist
Occupational Therapist
Qualified Speech Language Therapist
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*Includes Advanced Practice Registered Nurse

6. How can a Registry Participant report?
Individual provider
Can report individual measures or measure groups
Group Practice Reporting Option (GPRO)
Consists of two or more providers
Billing assignment is defined by a tax ID
Must register through EIDMS (April 1 - June 30, 2016)
Reports individual measures
Register with EIDMS through the portal at:
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7. Registry 2016 PQRS Reporting Requirements - EPs
Measure Type
Reporting Period
Criteria
Individual measures
12 months
Jan 1 - Dec 31, 2016
Data is aggregated by NPI
50% of Medicare FFS patients
9 measures across 3 NQS domains
1 cross cutting measure
Measures with a 0% performance rate will not be counted
Measure groups
Report on at least 1 measure group
20 patients, 11 must be Medicare FFS
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8. Registry 2016 PQRS Reporting Requirements - GPRO
Measure Type
Reporting Period
Criteria
Individual measures
2 – 99 EPs
12 months
Jan 1 - Dec 31, 2016
Data is aggregated at the TIN level
50% of Medicare FFS patients
9 measures across 3 NQS domains
1 cross cutting measure
Measures with a 0% performance rate will not be counted
and CAHPS for PQRS
2- 99 EPs
100+ EPs must report
CAHPS for PQRS
Must have all CAHPS for PQRS survey measures reported via a CMS certified survey vendor
Report on 6 additional measures outside CAHPS for PQRS survey
Covering at least 2 NQS domains
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9. The National Quality Strategy (NQS) Domains
MEASURE REQUIREMENTS
What is a Measure and How is it Counted?
The National Quality Strategy (NQS) Domains
In 2016, measures are classified according to the 6 NQS domains that CMS has prioritized
Patient Safety
Person and Caregiver-Centered Experience and Outcomes
Communication and Care Coordination
Effective Clinical Care
Community/ Population Health
Efficiency and Cost Reduction
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10. MEASURE REQUIREMENTS Denominator Numerator
PQRS Measure Denominators and Numerators
Measures consist of two major components: denominators and numerators
Denominator
Qualifies patient for the measure
Includes reporting frequency requirements (if applicable)
Can include patient demographic information
Can contain diagnosis and CPT/HCPCS code requirements
Numerator
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Contains the clinical guidelines for when to use each Quality Data Code (QDC) associated with the measure
Indicates whether measure will be met, not met, or considered a performance exclusion based on the QDC submitted

11. MEASURE REQUIREMENTS
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12. MEASURE REQUIREMENTS
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13. MEASURE REQUIREMENTS
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14. MEASURE REQUIREMENTS
How is a PQRS Measure Calculated?
Calculating the PQRS reporting rate (dividing the reported numerator outcomes by the denominator-eligible encounters) identifies the percentage of a patient population reported
For performance rate calculations, some patients may be subtracted from the denominator based on medical, patient, or system performance exclusions allowed by the measure
The final performance rate calculation represents the eligible population that received a particular process of care or achieved a particular outcome
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15. MEASURE REQUIREMENTS The CMS web page
2016 PQRS Individual Claims Registry Measure Specifications
2016 PQRS Measures Groups Specifications Supporting Documents
2016 Cross Cutting Measures
2016 Specialty Measure Sets
The web search tool (new for 2016)
Can lookup measures by measure number, reporting method, NQS domain, measure steward, and cross cutting measures
View in web tool or download and save measure specifications
Finding Measure Specifications
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16. PENALTIES AND AUDITS MAV
What happens if the minimum requirements are not met?
Measure Applicability Validation (MAV)
MAV
Inability to report 9 measures or 3 NQS domains or 1 cross cutting measure
Different process for claims-based and registry reporting methods
Applies to specialties with limited applicable measures
Reviews reported measures linked to measure clusters
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17. WHY ALPHAII and PI? Report on ALL quality metrics
All individual measures
All group measures
ALL specialty types and group sizes
Eligible professionals (EPs)
Group practices (GPROs)
FULLY INTEGRATED
No disruption to user workflow
Submitted when the claims are uploaded to EDI
Eliminates need for manual entry
Tasking identifies measures in error without stopping adjudication and reimbursement
Automatic submission to CMS
CMS sends confirmation to Alpha II
Alpha II forwards to EDI
Sophisticated analytics feedback
Ensures outcomes and attestations are met
Up-to-date metrics show percentage of reported measures in compliance
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18. LIVE DEMO - PI
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19. LIVE DEMO – Alpha II
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20. PQRS DEADLINES PQRS 2016 Timeline January 1st 2016
Reporting for the 2016 PQRS program year begins for both group practices and individuals (Note: 2016 program year data will determine the 2018 payment adjustment).
June 30th 2016
This is the last day that providers can sign up to submit as a GPRO with CMS. If this is not done prior to this date, all providers must report as an Eligible Professional (EP) with their individual NPI.
February 15th Submitter Registration and Entity Setup Deadline: All registrations must be submitted to Alpha II, LLC registration and Submitters must have entities created and measures selected by midnight on this date.
March 1st Final Report Data Load Deadline: All Submitter reporting data must be submitted to Alpha II, LLC by midnight on this date.  This means that all data must be submitted in an approved format and the Reseller’s Submitters must review and finalize their data through the Alpha II Registry portal by midnight on this date.  No data will be accepted after this deadline.
March 3rd 2017
Final Approval Attestation Deadline: The Reseller’s Submitters must complete the final approval attestation of data by midnight of this date.  There is a four-hour waiting period between the Finalize Report Data Load and the availability of the Final Approval Attestation.
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21. TAKE-AWAYS Easy to use CMS QUALIFIED Registry Instant Feedback
PI and Alpha II have streamlined this process to be as easy as possible with:
Auto Submissions
Direct and Easy User Interface
CMS QUALIFIED Registry
Includes ALL measures for Individual and Group reporting!
Instant Feedback
Integrated dashboard
Real-time percentages
Easy on the wallet, Big on Support
Competitive Pricing
Three layers of support
Deidre Speaker

22. NEXT STEPS Contact Your Reseller
Obtain and sign Provider End User Agreement to enroll
Kick Off Call
Review Customer and Task Setup
Review settings in the PQRS UI
Pick measures
Submit past claims
Train on continuing claim submission
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23. QUESTION AND ANSWER
Everyone