Reporting quality measures for PQRS via Medicare Part B claims is one of the most popular methods for participating in the CMS quality improvement program. However, since CMS has made it clear that they plan to phase out quality measures that can be reported via claims, it is a method that may not be available in future years. In 2015, only individual eligible professionals—not groups—may report PQRS via claims.
Claims-based reporting for PQRS involves submitting Quality Data Codes (QDCs), or G-codes, on Medicare Part B claims for applicable patients and selected quality measures. QDCs are non-payable Healthcare Common Procedure Coding System (HCPCS) codes composed of specified CPT Category II codes and/or G-codes that describe the clinical action required by a measure’s numerator. Some measures require more than one clinical action and may have more than one CPT Category II code, G-code, or a combination associated with them. To make sure that you are reporting the correct codes for the quality measures you choose for PQRS, you should review numerator reporting instructions for each measure carefully.
Eligible professionals reporting PQRS via claims in 2015 may satisfactorily report by meeting the following criteria:
Consider the following best practices if you choose to report via claims:
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