The Centers for Medicare & Medicaid Services' (CMS) Physician Quality Reporting System (PQRS) is a voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals (EPs) and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-For-Service (FFS) beneficiaries. The Physician Quality Reporting System (formally known as PQRI) was first implemented in 2007.
To learn more about this program, please visit CMS’ website at: http://www.cms.gov/PQRS.
How do I participate in PQRS?
If you choose to participate in PQRS, you can submit your claims real time (claim-based) or through a registry. If you choose to submit your PQRS real-time via claims, you can use the StreamlinePM+TM software to do this. If you are interested in participating you can contact your client advocate or the support desk at helpdesk@prcmedical.com.
If you choose to use a registry, we can create a file with the necessary patient information for you to submit to a registry. We currently support an interface with Outcome which charges $299.00 per provider ($278.00 per provider for MGMA members). We have the ability to support interfaces with other registries. If you are interested in using a registry please email Kami Green at kgreen@prcmedical.com.
What are the differences between claims and registry submission?
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PQRS Reporting Requirements at a Glance
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Group Measure Comparison
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Reporting Method
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Claims
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Registry
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Reporting Period
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6 or 12 months
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6 or 12 months
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Target Sample
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30 Part B FFS Medicare patients (12 months) or 50 percent of all Medicare patients for whom the measures apply (minimum of 8 patients for 6 months or 15 for one year)
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30 Part B FFS Medicare patients (12 months) or 50 percent of all Medicare patients for whom the measures apply (minimum of 8 patients for 6 months or 15 for one year)
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Submission Cost
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Free
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Yes, varies by registry
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Average Success Rate
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50 percent
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90 percent
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Workflow Considerations
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Real time data submission on a claim
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Data submission can occur after the date of service.
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Other Notables
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Must include intent to submit a group measure with a G code. Can use a composite G code.
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Zero performance measures will not be counted.
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Individual Measure Comparison
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Reporting Method
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Claims
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Registry
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Reporting Period
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6 or 12 months
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6 or 12 months
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Target Sample
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50 percent of all Medicare Part B FFS patients for whom the measures apply
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80 percent of all Medicare Part B FFS patients for whom the measures apply
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Submission Cost
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Free
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Yes, varies by registry
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Average Success Rate
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50 percent
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90 percent
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Workflow Considerations
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Real time data submission on a claim could impact chart prep.
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Data submission can occur after the date of service.
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Other Notables
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Submission should begin early 2011 for the best chance of success.
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Collection of clinical data should begin early.
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Source: AAPC Coding Edge, February 2011 edition