What’s new for Optometrists in 2016

2015 brought big changes for optometrists with regards to PQRS (the Physician’s Quality Reporting System). (See our 2015 blog here.) The number of measures jumped from three to nine, and ICD-10 also served to make reporting even more exacting. 2016 looks much the same in terms of measures and penalties, but there have been changes in reporting venues and of course diagnosis codes. It’s important to be aware of how this can help lead to a provider’s success or failure in PQRS reporting.

Big Change #1: ICD-10

The biggest difference of course is that your cheat sheet just got a whole lot longer! For instance, measure 2010F, ”Findings of dilated macular or fundus exam communicated to the physician or other qualified health care professional managing the diabetes care,” used to have six diagnosis codes to choose from. Now it has forty-six. But, the principle remains the same: you must link the appropriate code and ONLY the appropriate code to the PQRS measure line on your claim, or you will not get credit. Having a trustworthy EHR and a well-trained coding and billing team is vital here, especially if your office reports on claims.

Big Change #2: MORE Registry

For the first time, optometrists have their own specialty Registry for Meaningful Use and PQRS reporting. Check out the American Optometric Association’s website for more information and to enroll: http://www.aoa.org/more?sso=y. Enrollment for 2016 participation ends February 29, 2016. Currently supported EHRS include Officemate and EyefinityEHR, Compulink, RevolutionEHR, among others, with more vendors are being added all the time. The all-star optometry coding and billing team at Applied Medical Systems are well-versed in each of these EHRs and are happy to assist their providers in optimizing the use of their EHRs to get full reporting credit.

Why registry-report? Studies have shown that claims-based reporting is less accurate and more likely to fail than EHR or Registry-based reporting[1]. Not only that, claims-based reporting must be done at the time of service, and if it is missed there is no way to add the data after the fact. Registry or EHR reporting data does not have to be submitted until the end of the year.

What if my EHR doesn’t track PQRS measures?

Talk to your EHR representative. Make sure they are aware of how important it is to offer this feature and find out when it will be offered. Claims-reporting may disappear soon.

Then verify that your EHR is set up to code PQRS codes and add them to each encounter automatically. Although generally speaking automated coding will never take the place of a skilled certified coder, for PQRS reporting this is the best way to make sure all documented measures are reported. If your EHR doesn’t support automated PQRS coding, it is imperative to make sure the doctors and coding staff are trained to manually code these measures.

What if I don’t have an EHR?

If you don’t currently have an EHR,  it is recommended that you begin the process of selecting one as soon as possible. With each year that passes, the government places more burdens on the providers to document and report measures to track quality of care. Paper charting will soon become untenable. Your representative at Applied Medical Systems will be happy to help you with the selection process.

In the meantime, you will need to report your PQRS via claims-based reporting. Make sure your coders are trained to do this at the time of service; if the claim is submitted without the proper codes, there is no way to recover that encounter.

Do I have to participate in PQRS reporting?

Participation is not mandatory yet. However, failure to have successfully reported in 2015 will result in a 2% reduction in all Medicare payments paid in 2017. Failure to report in 2016 will result in a further reduction in 2018. For example: if an office’s total annual Medicare compensation is $55,000, a 2% reduction translates to $1100.00 less revenue.

Some offices with very small numbers of Medicare patients decide that the cost of reporting is higher than the penalty assessed.  It is a good idea to run this calculation for your office and compare it to your reporting costs. However, bear in mind that CMS may choose to take this option away as early as next year.

What are the 2016 reporting requirements?

As we mentioned above, the requirements haven’t changed considerably for optometrists this year. The requirement is still to report on at least 9 measures including at least one cross-cutting measure (these are non-eye-specific measures, such as medication tracking or tobacco use, that apply to all Medicare patients.) See our 2015 blog for details.

I have more questions. Where can I find more information? Medicare’s website is chock-full of general information on PQRS reporting. For optometry-specific reporting, see the American Optometric Association’s website. For questions on how to sync your EHR with the Registry, contact your EHR’s tech support directly. And of course, if you have any questions at all, feel free to contact Lead Optometry Biller Anna Wade at Applied Medical Systems. awade@ams-nc.com or 919-354-2946. We’ll do whatever we can to get you pointed in the right direction.
[1] http://www.webpt.com/blog/post/why-providers-should-go-registry-based-instead-claims-based