Free help with quality reports from TMF
For no-cost technical assistance on how to access and interpret your report, turn to the TMF Quality Innovation Network Quality Im- provement Organization (QIN-QIO),
www.tmfqin
.org. Under contract with Medicare, TMF QIN-QIO provides free consulting services and technical assistance to solo physi- cians, group practices, and other health care professionals for Medi- care’s quality programs. For help with your
quality reports or the informal review request process, call Tracy Swo- boda at TMF QIN-QIO at (361) 285-1053 or email tracy.swoboda@area-b
.hcqis.org. And join the free TMF Value-Based Improvement and Out- comes Network, www
.tmfqin.org/Networks/ Value-Based-Improve ment-and-Outcomes, to learn to successfully participate in the PQRS and VBM programs to improve performance and maximize your Medicare payment.
You must provide the patient a copy of any portion of the record you haven’t specifically denied him or her access to within a reasonable time, and you “may charge a reasonable fee.” According to the white paper, it
is unclear whether the TMB rules regarding fees for medical records generally apply to fees for copies of mental health records, specifically. The regulations do not mention this portion of the Health and Safety Code. Nonetheless, it may be prudent for physicians who are mental health “professionals” to follow the TMB rules in this area, the white paper says. The white paper is one of a series
on medical records from TMA’s Office of the General Counsel on the TMA Medical Records resource page, www
.texmed.org/Medical_Records (log-in required for most).
Review your PQRS feedback report and QRUR by Nov. 9 deadline
IF YOU SUBMITTED DATA to Medi- care’s Physician Quality Reporting System (PQRS) for the 2014 reporting period, now is the time to review your quality reports. The reports include information about your quality and cost performance ratings and whether you’ll get hit with penalties or receive bonus payments. You must act quickly, as the deadline to appeal any errors is Nov. 9, 2015. Medicare is moving toward physi-
cian payment based on value ratings rather than volume. The intent of the quality programs is to let you assess the quality and efficiency of your med- ical care through feedback reports so you can identify gaps in care and im- prove performance, resulting in better care and reduced costs for Medicare fee-for-service beneficiaries. Medicare recently released the
2014 PQRS feedback reports, which contain information about your qual-
20 TEXAS MEDICINE November 2015
ity performance and whether you will receive a payment cut in 2016 or an incentive payment this year. If you re- ceive the penalty, you will be subject to a 2-percent pay cut on a per-claims basis under the 2016 Medicare Physi- cian Fee Schedule. If you are eligible for the bonus, Medicare will issue a separate, consolidated incentive pay- ment to you electronically or via check later this fall. The other report is the annual
Quality and Resource Use Report (QRUR), and it is available to all solo physicians and group practices this year. The QRUR is a component of Medicare’s value-based payment mod- ifier (VBM) program. The VBM aligns with and is based on your participa- tion in PQRS. The QRUR provides detailed infor-
mation about your quality ratings and cost performance and how you com- pare to your peers. Under this pro- gram, Medicare used quality and cost data from 2014 to calculate the value- modifier score for group practices with 100 or more eligible profession- als. That score determines whether the physicians in the group practice will receive an adjustment payment boost, no change, or a cut of up to 2 percent on a per-claims basis under the 2016 fee schedule. For group practices with 10 to 99
eligible professionals, physicians will experience either no payment change or a 2-percent increase in 2016. High performers treating high-risk ben- eficiaries will receive an additional 1 percent in payment in both group sizes. For solo physicians and smaller group practices, the QRUR is provided for informational purposes this year, and the VBM will not affect payment in 2016. In 2017, the VBM will apply to all
solo physicians and groups regard- less of practice size, based on 2015 data. Read more in “Technical As- sistance Required,” July 2015 Texas Medicine, pages 59–62, or visit www
.texmed.org/TechnicalAssistance Required.
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