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I am having too many issues with pulling data for PQRS 2014 reporting with GE.
I am confuse on what Insurance I need to apply SOP codes.
At first, I thought only to original Medicare FFS plans but now GE is asking to apply to all. So do we need to apply SOP code to each Insurance carrier in our EMR?
other issue we have to run query to assign SOP to previous 2014 office visit and export patient to CQR..do we have to run query on each Insurance carrier?
Anybody using GE to report PQRS? Do you all know what is required?
I am totally confuse. Please help!
Posted : January 28, 2015 5:19 am
Yes, you have to run a inquiry for EACH insurance plan, and hit the button. There is no way to have the criteria for the visit date and then OR all the plans together and run one inquiry. It is a PAIN, and much more difficult than they make it out to be in the presentation.
I matched all my medicare plans to medicare FSS, ran about 20 inquiries for each of these plans and as directed and "pushed the button" for each resulting set of patients on Sunday morning.
I then hit the calculate button in the QRS.
I see no data in CQR, and the MQIC tab is not enabled for me, I get a "THIS IS ONLY FOR QSS USERS"
I am not going to go back and match one of the 185 SOP codes to each of my insurance plans and run an inquiry for each, if I have to, I will just file a complaint with CMS or something....
I opened a case on Monday with GE and haven't gotten no response back, other than, yes I should be able to see the MQIC tab. I mean I see it, but it is not enabled for me.
Judging by the fact that they just extended the deadline again to next week, I don' think they have their act together. Old MQIC was never an issue for us, we have been doing it for years.
Posted : January 28, 2015 5:41 am
Sorry there is only 146 SOP codes, not 185. now which ones go with witch of my 145 insurance plans.....
| MEDICARE |
| Medicare (Managed Care) |
| Medicare HMO |
| Medicare PPO |
| Medicare POS |
| Medicare Managed Care Other |
| Medicare (Non-managed Care) |
| Medicare FFS |
| Medicare Drug Benefit |
| Medicare Medical Savings Account (MSA) |
| Medicare Non-managed Care Other |
| Medicare Other |
| MEDICAID |
| Medicaid (Managed Care) |
| Medicaid HMO |
| Medicaid PPO |
| Medicaid PCCM (Primary Care Case Management) |
| Medicaid Managed Care Other |
| Medicaid (Non-managed Care Plan) |
| Medicaid/SCHIP |
| Medicaid Applicant |
| Medicaid - Out of State |
| Medicaid Other |
| OTHER GOVERNMENT (Federal/State/Local excluding Department of Corrections) |
| Department of Defense |
| TRICARE (CHAMPUS) |
| TRICARE Prime - HMO |
| TRICARE Extra - PPO |
| TRICARE Standard - Fee For Service |
| TRICARE For Life--Medicare Supplement |
| TRICARE Reserve Select |
| Uniformed Services Family Health Plan (USFHP) -- HMO |
| Department of Defense - (other) |
| Military Treatment Facility |
| Enrolled Prime - HMO |
| Non-enrolled Space Available |
| TRICARE For Life (TFL) |
| Dental --Stand AlonePublic Health Data Standards Consortium |
| Department of Veterans Affairs |
| Veteran care--Care provided to Veterans |
| Direct Care--Care provided in VA facilities |
| Indirect Care--Care provided outside VA facilities |
| Fee Basis |
| Foreign Fee/Foreign Medical Program(FMP) |
| Contract Nursing Home/Community Nursing Home |
| State Veterans Home |
| Sharing Agreements |
| Other Federal Agency |
| Non-veteran care |
| Civilian Health and Medical Program for the VA (CHAMPVA) |
| Spina Bifida Health Care Program (SB) |
| Children of Women Vietnam Veterans (CWVV) |
| Other non-veteran care |
| Indian Health Service or Tribe |
| Indian Health Service - Regular |
| Indian Health Service - Contract |
| Indian Health Service - Managed Care |
| Indian Tribe - Sponsored Coverage |
| HRSA Program |
| Title V (MCH Block Grant) |
| Migrant Health Program |
| Ryan White Act |
| Other |
| Black Lung |
| State Government |
| State SCHIP program (codes for individual states) |
| Specific state programs (list/ local code) |
| State, not otherwise specified (other state) |
| Local Government |
| Local - Managed care |
| HMO |
| PPO |
| POS |
| FFS/Indemnity |
| Local, not otherwise specified (other local, county) |
| Other Government (Federal, State, Local not specified) |
| Federal, State, Local not specified managed care |
| Federal, State, Local not specified - HMO |
| Federal, State, Local not specified - PPO |
| Federal, State, Local not specified - POS |
| Federal, State, Local not specified - not specified managed care |
| Federal, State, Local not specified - FFS |
| Federal, State, Local not specified - OtherPublic Health Data Standards Consortium |
| Other Federal |
| DEPARTMENTS OF CORRECTIONS |
| Corrections Federal |
| Corrections State |
| Corrections Local |
| Corrections Unknown Level |
| PRIVATE HEALTH INSURANCE |
| Managed Care (Private) |
| Commercial Managed Care - HMO |
| Commercial Managed Care - PPO |
| Commercial Managed Care - POS |
| Exclusive Provider Organization |
| Gatekeeper PPO (GPPO) |
| Managed Care, Other (non HMO) |
| Private Health Insurance - Indemnity |
| Commercial Indemnity |
| Self-insured (ERISA) Administrative Services Only (ASO) plan |
| Medicare supplemental policy (as second payer) |
| Private health insurance - other commercial Indemnity |
| Managed Care (private) or private health insurance (indemnity), not otherwise specified |
| Organized Delivery System |
| Small Employer Purchasing Group |
| Other Private Insurance |
| BLUE CROSS/BLUE SHIELD |
| BC Managed Care |
| BC Managed Care - HMO |
| BC Managed Care - PPO |
| BC Managed Care - POS |
| BC Managed Care - Other |
| BC Indemnity |
| BC (Indemnity or Managed Care) - Out of State |
| BC (Indemnity or Managed Care) - Unspecified |
| BC (Indemnity or Managed Care) - Other |
| MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private) |
| HMO |
| PPO |
| POS |
| Other Managed Care, Unknown if public or private |
| NO PAYMENT from an Organization/Agency/Program/Private Payer ListedPublic Health Data Standards Cons |
| Self-pay |
| No Charge |
| Charity |
| Professional Courtesy |
| Research/Clinical Trial |
| Refusal to Pay/Bad Debt |
| Hill Burton Free Care |
| Research/Donor |
| No Payment, Other |
| MISCELLANEOUS/OTHER |
| Foreign National |
| Other (Non-government) |
| Disability Insurance |
| Long-term Care Insurance |
| Worker's Compensation |
| Worker's Comp HMO |
| Worker's Comp Fee-for-Service |
| Worker's Comp Other Managed Care |
| Worker's Comp, Other unspecified |
| Auto Insurance (no fault) |
| Other specified (includes Hospice - Unspecified plan) |
| No Typology Code available for payment source |
| Unavailable / Unknown |
Posted : January 28, 2015 5:46 am
Look at the GE Portal, there was an email sent yesterday with updated instructions to send the updated SOP codes to CQR without having to do in in reports by each insurance carrier.
I too am stuck on the type of SOP per insurance. What about Skilled Nursing Centers you have to bill for services if Medicare patient is inpatient with them. What about Liability claims. Is Federal BCBS under BCBS PPO or Federal? At this point I am doing the best I can and hoping for the best.
Posted : January 28, 2015 6:02 am
We followed the instructions too per the webinar slides. Refreshed the CQR dashboard Monday and now NO REPORTS/DATA are being displayed including MU reports.
Then GE released new instructions that was NOT included in the webinar. VERY FRUSTRATING.
Has anyone been successful in getting accurate reports?
Posted : January 28, 2015 8:15 am
We have been on numerous phone calls with GE support. We tore into one of them the other day and they broke down and admitted that GE has left them stranded. They, as support, even felt abandoned. They have called and emailed the higher ups and got no response to their questions, which are the same questions we are asking. On top of that, Jane Slayden is out of the office from the 27th to the 30th! Are you kidding me??? GE finally sets up MQIC a week and a half from their deadline of January 31st on this dying system and now Jane Slayden is out till the deadline! These people need to get their stuff in order, this is ridiculous. Perhaps a class action lawsuit will put their heads back where they should be.......
Sorry...
/rant
Posted : January 28, 2015 1:11 pm
If you refresh again today, 2/2, you'll probably see data. Data is coming back much, much more quickly today (15-minutes) than it did last week (5-6 hours). That's on both cqr.gehealthcare.com and gamma.cqr.gehealthcare.com
The Medicare lists, however, are still incorrect. While a few patients show up under Medicare, many more (often with the same exact Medicare Insurance Plan) are in the 'OTHERS' or 'PRIVATE' category.
Posted : February 2, 2015 5:23 am
WARNING WARNING WARNING!!!!
It is not you, it is GE.
Just got off the phone with GE Support after spending multiple hours making sure we did everything to the tee that GE has required. Everything from correct SOP codes, resetting subscriptions, data ingestion and finally CQR re-calculations.
After ensuring we did all the correct steps, our Medicare Only denominators still were extremely low (i.e. inaccurate) in the CQR Dashboard.
As pre-work to the GE Support call we zeroed in on one provider and found an example of a true medicare only patient that DID have an office visit in 2014 and met ALL denominator criteria for CQR CMS22 Measure. As suspected, the patient was NOT shown in the CQR Dashboard when filtered by Insurance: Medicare.
Incidentally, the patient was found in the Filter By: All category.
GE support initially tried to say that all was well and it was just OUR misunderstanding of the measure denominator's criteria. We knew better and stuck to our guns, as we knew that the patient should have been found in the CQR CMS22 Medicare group's denominator. At that point the support tech acknowledged that GE sent an INTERNAL only email at 1:30 today to the GE support staff stating that there is a known filter issue in CQR and that they have no estimated time to fix. It is SPR 62450.
Our support technician has advised us to sit tight until a fix from GE is issued as there is nothing the customer can do to resolve this problem.
So we sit here on our hands with the 2/13/15 deadline FAST approaching.
Anyone willing to hire two ex PQRS program managers? ...as we most likely will be unemployed when our doctors (company owners) find out we were unsuccessful in submitting PQRS data due to our Vendor not having filters that work.
Posted : February 10, 2015 12:42 pm
I didn't think my numbers looked correct at first glance either. Was waiting and was going to deep dive on one, but looks like you did it for me. Thanks.
Posted : February 10, 2015 1:05 pm
mcwilson -- check to see if the patients NOT appearing are missing Effective Date on insurance. I was working with my GE CQR rep and she noticed that correlation.
I wrote an SQL and doubled the Medicare bucket instantly:
Posted : February 11, 2015 3:39 am
select pid,effectivedate,idno,grpno,db_create_date,db_updated_date from ml.insuranc where effectivedate is Null and psistate = 'P' and pid in (select pid from ml.document where doctype =1 and db_create_date >= '01-JAN-14') and pid in (select pid from ml.person where ispatient = 'Y') --and homelocation in (select locid --from ml.locreg where abbrevname in ('LOC1','LOC2') --) AND INSPLANID IN (select insplanid from ml.insureco where inssourceofpaymentsid in (select inssourceofpaymentsid from ml.inssourceofpayments where description = 'Medicare FFS')) and grpno is null;
Posted : February 11, 2015 3:40 am
Too many hours and working weekends have been spent ensuring that all the steps have been followed to the tee to only find out I have SEVERAL providers who have NO DATA returned. These providers happen to be specialists. I wonder, do we submit and pay $275 per provider just to avoid a 2016 penalty? I am beyond frustrated! As a last resort I will look into the missing effective date on insurances.
Posted : February 11, 2015 4:10 am
thanks for the query on effective date, is that confirmed that that is required for this to work? none or ours are populated.
Suppose I will run a mass update SQL with an arbitrary date......
Do you have that update query?
Posted : February 11, 2015 6:56 am
I updated the insurance effective date and my numbers came up.
Things still look a bit messed up though, for instance some denominators are higher than the number of medicare patients we have, when filtered for medicare.
Posted : February 12, 2015 9:10 am
We were just told by a support tech, that GE will be sending out a statement later today about the effective date and Medicare filter issue. That was all she was willing to say at this point.
Guess we will stay tuned.
Steph B.
Posted : February 12, 2015 10:41 am
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