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Physician Quality Reporting System Incentive Program
It's not too late! There are several opportunities to participate in the 2011 Physician Quality Reporting System (PQRS) Program.
- Claims-based reporting of INDIVIDUAL MEASURES for July 1 - December 31, 2011
- Claims-based reporting of one MEASURES GROUP for July 1 - December 31, 2011
- Registry-based reporting of INDIVIDUAL MEASURES for July 1 - December 31, 2011
- Registry-based reporting of one MEASURES GROUP for July 1 - December 31, 2011
- Certified EMR-based reporting of INDIVIDUAL MEASURES for July 1 - December 31, 2011
- This is the newest option available in the PQRS incentive program and is available through your HealthInsight Regional Extension Center Project Coordinator. Please contact us at rec@healthinsight.org for more information.
Even if you are not participating in the PQRS Program, you may be eligible to receive an incentive payment equal to 1.0% of your total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished July 1, 2011- December 31, 2011. You can also potentially qualify to receive an incentive payment equal to 1.0% of your total estimated Medicare Part B PFS allowed charges for covered professional services furnished during the entire year by reporting at least one measures group on 30 unique patients via claims or registry submission.
STEP 1:
Determine if you are eligible to participate. A list of eligible professionals* will help you determine if you are eligible and able to participate in PQRS.
STEP 2:
Determine which PQRS reporting option(s) and reporting period best fits your practice. This information can be found in Appendix C of the 2011 Physician Quality Reporting System Implementation Guide*.
STEP 3:
Review the 2011 PQRS Measures List*, and determine which measures apply.
Select at least three applicable measures. If fewer than three measures are reported, CMS will apply a measure-applicability validation (MAV) process when determining incentive eligibility.
STEP 4:
Individual Physician Quality Reporting Measures
Once you have selected the measures (at least three), carefully review the following documents:
- 2011 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry* for instructions on how to report claims-based or registry-based individual measures. Just print the pages for the measure specifications you are reporting, as the document is very lengthy.
- 2011 PQRS Implementation Guide*, which describes important reporting principles underlying claims-based reporting of measures and includes a sample claim in Form CMS-1500 format.
As you read the specifications and reporting instructions, please take note of the QDC and modifiers (a Current Procedural Terminology [CPT] II code or G-code) associated with it. To qualify for the incentive, the correct numerator QDC must be reported on at least 80 percent of eligible instances if reporting via a registry or 50 percent of the eligible instances if reporting via claims for each selected measure. Also, familiarize yourself with the measure tag (reporting frequency or timeframe requirement) associated with each measure.
Or: As an alternative to reporting three individual measures, you can select to report one or more measures groups.
PQRS Measures Groups
Once you have selected a measures group(s) to report, carefully review the following documents:
- 2011 Physician Quality Reporting Measures Groups Specifications Manual and Release Notes*, for claims-based or registry-based reporting of measures groups. Just print the pages for the measure specifications, including denominator coding, you are reporting. Note that the specifications for a measures group are different from those for individual measures because they identify a common denominator across the measures group. Be sure you use the correct specifications.
- Getting Started with 2011 Physician Quality Reporting of Measures Groups* is the implementation guide for reporting measures groups.
If selecting either of the claims-based reporting options, you must attach a Quality-Data Code (QDC) to each claim submitted for services when billing Medicare Part B.
If you select one of the registry-based reporting options, then the registry will submit this quality data directly to Medicare, eliminating the need for adding QDCs to the Medicare Part B claim. However, you must be using a CMS qualified registry. A list of qualified registries for 2011 Physician Quality Reporting System will be available later this year.
For more information, please contact HealthInsight at 800-483-0932 or rec@healthinsight.org
*You may be directed to a license agreement page before you can open each document. Please accept the terms of the agreement to continue. | 
