Demystify Your Physician Quality Reporting System Dilemmas

Read this expert healthcare training article and let these questions and answers clarify your CMS PQRS doubts.

Question: Why should one participate in the PQRS?

Answer: Participation obviously, it's voluntary. But the reason you want to participate is because this is where the federal government is taking us. We're moving towards value-based purchasing. And it's going to revolve around quality of care.

So, your payments will hinge on the performance of quality care. So it's important that if you're not exercising this already, you need to get involve because when it's finally comes down to your payment being based on performance, you don't want to be behind the (wire) on that. So, make sure you're participating now when it will not cost you and there's still an incentive for you.

Question: Is the primary diagnosis the only diagnosis that is the applicable to the quality measure being reported or will the Physician Quality Reporting System considered all diagnoses reported on the claim?

Answer: From what we have researched, they're saying that it doesn't matter which diagnosis. But we've also seen in some reporting scenarios based on our feedback reports where we had diagnosis code errors that causes us to fail or cause the failure in the reporting of certain PQRS measures.

When we did some researched on it, we saw cases where we had submitted secondary diagnostic codes or that the denominator ICD-9 code was in the secondary position. Although we couldn't confirm it, we think that that's what the link was.

So, we would have tried to report it as a primary, if not a secondary. We think when you get beyond that, you could possibly create more problems for yourself.

Question: Will physician quality reporting support clinical performance measure result be publicly reported?

Answer: Right now they're not going to do that. They're not going to expose providers on that level. They are looking to expose the data eventually. Basically, they're not going to identify the actual docs but they are looking to put this data after as an overall or an overview of how providers in the country are doing with these various measures.

But at this point, I on the hospital side, some hospitals are actually, you can go in and look in each different hospital and see how they are performing on these different things. And as of this point, we haven't seen where CMS is going to do that with doctors just yet, but you may expect to see that in the future.

To get more healthcare training on CMS PQRS updates, visit our Physician Quality Reporting System page.