It is that time of year again—time to start thinking about reporting for the Physician Quality Reporting System (PQRS). With MIPS penalties set to start in CY 2019, the final year of payment adjustments under the Physician Quality Reporting System will come in CY 2018 and will be based on data reported during this year. As such, it is critical that physicians who are eligible for PQRS actually participate this year, even if the only mechanism available is via claims. In 2016, only individual eligible professionals may report PQRS via claims, as the reporting mechanism is not available to groups participating in PQRS via the Group Practice Reporting Option (GPRO).
CMS made a big push to provide additional resources for PQRS this year, although it seems a bit late given that the program may end. Regardless, these new resources should make PQRS participation a bit easier this year, especially for folks who are just jumping on the bandwagon:
Claims-based reporting for PQRS involves submitting Quality Data Codes (QDCs), or G-Codes, on Medicare Part B claims for applicable patients and select 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. A complete list of the specifications and measure flow sheets for the 2016 PQRS Claims and Registry Individual Measures can be found on the CMS website.
Eligible professionals reporting PQRS via claims in 2016 may satisfactorily report by meeting the following criteria:
The following best practices should be followed if you choose to report PQRS in 2016 using the claims-based reporting mechanism:
Reporting quality measures 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 it plans to phase out quality measures that can be reported via claims, it may be worth exploring other reporting options this year in case CMS decides to do away with claims reporting under any new programs that come out of the MACRA legislation. For physicians who have previously relied on claims reporting, the registry reporting option may be the easiest transition.
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