Medicare Quality Reporting

The Centers for Medicare and Medicaid Services (CMS) have implemented three clinician-level programs to promote improvements in the quality of care provided to beneficiaries. As the Medicare program continues to evolve into a pay-for-value system, it is important for providers to understand each of these programs and their associated requirements.

Electronic Health Record (EHR) Incentive Program

The federal government developed the Electronic Health Record (EHR) Incentive Program to encourage use of health information technology. Under the program, qualified physicians that demonstrate "meaningful use" of EHR technology and performance between 2011 and 2015 can receive bonus payments. Click here to learn more >>>

Value-Based Payment Modifier

The Value-Based Payment Modifier, or Value Modifier, provides bonus payments or penalties to eligible professionals based on the quality and cost of care provided during a performance period. The Value Modifier is aligned with the reporting requirements of the Physician Quality Reporting System (PQRS). The 2016 Value Modifier is currently being applied to groups of 10 or more eligible professionals based on 2014 performance. The 2018 Value Modifier, which is based on 2016 performance, will be applied to all physicians, including solo practitioners, and all non-physician eligible professionals (physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists). Click here to learn more >>>

Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) collects data on the quality of care provided to Medicare beneficiaries based on clinician performance against selected quality measures. A -2 percent payment adjustment will be applied to Medicare Part B payments in 2018 for providers who do not satisfactorily report data on quality measures for covered professional services throughout the 2016 program year. Providers should review their options for PQRS reporting to ensure that they are utilizing the most efficient mechanism for their practice. Click here to learn more >>>

The ACC’s PINNACLE Registry is an accepted Qualified Clinical Data Registry individual reporting option for 2016 PQRS.

Core Quality Measure Collaborative Cardiovascular Measures

In 2015, the ACC participated in the Core Quality Measure Collaborative (CQMC), led by America’s Health Insurance Plans and the Centers for Medicare and Medicaid Services (CMS), to establish a set of measures intended for use across a broad spectrum of stakeholders including commercial health plans, consumers, and physicians. The measures are intended to increase alignment and ease the reporting burden of measures to public and private payers. Click here to learn more >>>

Appropriate Use Criteria Program

The Protecting Access to Medicare Act of 2014 includes a provision requiring ordering professionals to consult with appropriate use criteria (AUC) through a clinical decision support mechanism (CDSM) for all Medicare patients receiving advanced imaging (cardiac nuclear, CT, MR). Under the law, only AUC developed by entities meeting the “provider-led entity” (PLE) standards as defined by regulation can be used under the Centers for Medicare and Medicaid Services’ AUC Program. The ACC meets requirements to be a qualified PLE to develop and modify AUC under the Medicare AUC Program for advanced diagnostic imaging. As a result, the national AUC developed by the College will be an accepted standard for cardiologists and others when submitting to Medicare for the review of cardiac imaging. Click here to learn more >>>