Your reimbursement for Medicare services will become more and more dependent on various quality and cost indicators. The two major quality and cost measurements are your performance in the:
- physician quality reporting system (PQRS); and
- the value modifier program.
By reporting on PQRS quality measures, you can quantify how often you are meeting a particular quality metric. The value modifier program combines quality and cost. The Quality and Resource Use Report (QRUR) provides information on six cost measures and three claims-based quality outcome measures for beneficiaries that are attributed to you. These measures are used to calculate the value modifier. Both of these groups of measurements will ultimately impact your reimbursement. You will want to pay special attention to whether beneficiaries are attributed to you and, if you believe attribution is inappropriate, you may want to request an informal review. Additional information about how to request an informal review is available on the 2015 QRUR website and through the QRUR Help Desk at email@example.com or 888-734-6433 (select option 3).
Both the PQRS Feedback Report and QRUR will be released by CMS in September, and will be of great importance, to track your quality progress. In order to access these reports - this year and in coming years - you will need to have an enterprise identity management (EIDM) account.
The following notice from CMS explains how you can sign-up for an identity enterprise management (EIDM) account or ensure that your existing account is active. We encourage you to create your EIDM account now, as the signup process is lengthy. This quality reporting information will become more and more important to your CMS reimbursement and you will want to access the data on a regular basis.
Reminder: Prepare to Access 2015 PQRS Feedback Reports and Quality and Resource Use Reports with an EIDM Account
CMS has sent out a series of messages regarding the 2015 PQRS feedback reports and 2015 Annual Quality and Resource Use Reports (QRURs), and what to do to prepare to access them. The PQRS feedback reports depict your program year 2015 PQRS reporting results, including payment adjustment assessment for calendar year 2017. The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. Both reports will be available early fall.
Prepare now by either signing up for an Enterprise Identity Management (EIDM) account or ensuring that your existing account is active. EIDM accounts are required for participants to obtain 2015 PQRS feedback reports and 2015 Annual QRURs. The same EIDM account can be used to access both reports. To register for an EIDM account, visit the CMS Enterprise Portal and click “New User Registration” under “Login to CMS Secure Portal.” For additional resources, you may also view the EIDM Quick Reference Guides (QRGs) located on the Physician and Other Health Care Professionals Quality Reporting Portal. You may access these from the middle of the webpage, under the “sign in” button. These QRGs contain step-by-step instructions for requesting an EIDM account.
Once you have an EIDM account, you will have to select the appropriate user roles in order to access your PQRS feedback reports and 2015 Annual QRUR:
Individual Roles: The individual roles are available to eligible professionals (EPs) or representatives of an EP that is a sole proprietor and is paid under a Tax Identification Number (TIN)/National Provider Identifier (NPI) for the Medicare Physician Fee Schedule (MPFS). For this situation, this would be the only EP billing MPFS under this TIN/Social Security Number (SSN). The 2 roles are:
- Individual Practitioner – The first role requested for a TIN. Allows the user to approve other role requests and access PQRS feedback reports and QRURs based on the TIN for which the role was requested.
- Individual Practitioner Representative – Allows users access to PQRS feedback reports and QRURs based on the TIN for which the role was requested.
Group Roles: The group roles are available to EPs or representatives of a TIN that have 2 or more providers receiving MPFS payments under the TIN. These roles are not limited to those TINs that are participating as PQRS group practice but would also include TINs where the EPs under the TIN are reporting individually. The 2 roles are:
- Security Official – The first role requested for a TIN. Allows the user to approve other role requests and access PQRS feedback reports and QRURs based on the TIN for which the role was requested.
- Group Representative – Allows users access to PQRS feedback reports and QRURs based on the TIN for which the role was requested.
Note: For those participating in an Accountable Care Organization (ACO), the role requests would be made for each individual TIN under the ACO.
For additional assistance regarding EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715- 6222) from 7:00 a.m. to 7:00 p.m. Central Time, Monday through Friday, or via email at firstname.lastname@example.org. To avoid security violations, please do not include personal identifying information such as Social Security Number or Tax Identification Number in email inquiries to the QualityNet Help Desk.
Information about the 2015 Annual QRURs is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2015-QRUR.html.