2015 PQRS Reports: Reporting Rate vs Performance Rate

November 28, 2016
Rick Gawenda

By now, some physical and occupational therapists as well as speech-language pathologists in private practices have received a letter notifying them that they did not satisfactorily report PQRS measures in calendar year 2015 and would be subject to a 2% payment reduction in their calendar year 2017 Medicare payments. If you did not receive a letter or you are not sure if you successfully reported PQRS measures in 2015, I will provide a link later in this article where you can access your reports.

In the past 2 weeks, I have received several phone calls and emails from therapists in private practice due to receiving a letter stating they did not successfully report all applicable PQRS measures in calendar year 2015. However, the therapists tell me that they did report on all applicable measures on at least 50% of their eligible patient’s and their reports actually support their statement.

The key word though is report. The therapists did satisfactorily report on at least 50% of measures applicable to their discipline and by means of reporting (i.e. claims vs registry). The key though is their Performance Rate on one or more of their measures and Performance Rate and Reporting Rate do not mean the same thing.

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  1. For the diabetes measures, the therapist would have to enter one of the diagnoses for diabetes in order for those patients to be eligible. If the therapist does not use the diabetes diagnosis, and never enters the diabetes measures, their performance rate would be 0/0, would that be considered passing?

  2. I have read this and I could use some help please. Can someone reach out to me so I can go over some practice specific besides falls

  3. Rick – I am interested in having someone make this PQRS info clear to me. I do not believe our Rehab office is a Gold Member. According to above, if we become a Gold Member the PQRS information becomes accessible to our facility. My concern is I will become a Gold Member and will read the info and still be confused. Please advise. V/r Louann King