A Survival Guide to PQRS Reporting

October 7, 2014 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management

Over the last few years Meaningful Use and ICD 10 have received most of the attention from the press and professional societies, but in our experience it is PQRS requirements that most practices are failing in their preparation and reporting. 

The CMS’ Physician's Quality Reporting System is a program designed to “promote reporting of quality information” by physicians and other eligible professionals (EPs). Physician's Quality Reporting System began as an incentive program, issuing bonus payments to practices that satisfactorily reported data on services delivered to Medicare Part B beneficiaries. But the program is shifting to a penalization phase. Beginning in 2015, non-reporting EPs will see negative payment adjustments for failing to participate.

If you’re not already informed about PQRS, you need to be. To help you avoid penalties, NCG Medical has compiled this Physician;s Quality Reporting System Guide – a Q&A directory of information you need to navigate the program requirements.

What is the purpose of Physician's Quality Reporting System?

It’s about improving quality of care. Reporting gives providers an opportunity to assess the quality of care they are providing to patients and quantify how often they are meeting particular quality metrics. They can also compare their performance on certain quality indicators against that of their peers. (More details available here.)

Who is an ‘Eligible Professional?’

Eligible covered professionals are those paid under or based on the Medicare Physician Fee Schedule (PFS). If you’re on this list from the CMS, you’re considered an EP.

What identifying information is required?

You need both National Provider Identifier (NPI) and Tax Identification Number (TIN) to prove your status as an EP.

How do I register?

There is no sign-up or registration process for the program. If you qualify as an EP, you start by selecting your reporting participation method. (See ‘How do I report?’ below.)

How can I benefit from participating?

2014 is the last year for potential incentive payments. Report this year for a potential 0.5% bonus payment from CMS.

Am I required to participate?

You’re not technically required, but there are non-participation consequences for EPs and you may already be headed toward a penalty if you didn’t report 2013 data: 

  • In 2015, you’ll see a -1.5% payment adjustment if you failed to report 2013 data. 
  • In 2016, you’ll see a -2% payment adjustment if you fail to report 2014 data

How do I report?

You have five options for reporting, and you’ll need to assess your options to determine which one is the best fit for you. 

  • Claims-based reporting (submitting CPT II or G codes). Claims-based coding & reporting principles available here
  • Reporting to a CMS-approved registry. 2014 qualified registries listed here
  • Utilizing a qualified electronic health record product. Details and vendors available here
  • Utilizing a Qualified Clinical Data Registry (which reports your EHR data to CMS. 2014 QCDRs listed here
  • Utilizing the Group Practice Reporting Option

What is the GPRO?

A group practice can register to participate through the group practice reporting option (GPRO). To be eligible, the group must be defined by a single Tax Identification Number with two or more individual EPs (each with respective NPIs.)

GPRO participants have different reporting options available to them depending on the size of their group. Full GPRO details are available here

What will I be measured on?

That depends on your specialty and selected reporting option, though your practice will have some ability to determine which metrics on which you want to report on. For full details, see the CMS’ 2014 PQRS Measure List Implementation Guide here

What are my reporting deadlines year-by-year?

The latest CMS Physician's Quality Reporting System timeline, available here, lists all milestones and deadlines providers need to know.

For more information or further assistance with PQRS 2014 registry reporting, do not hesitate to contact NCG Medical,  a medical billing company offering integrated revenue cycle management, practice management & certified EHR services, headquartered in Orlando, FL.

 800.959.1906 or send us an e-mail at solutions@ncgmedical.com
Need Help With PQRS? Contact Us.



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