Healthcare Training: Simplify your PQRS Process


The Physician Quality Reporting System  is a significant way to improve the care of the patients you serve, but it's also a great way to earn financial incentives. CMS created a GPRO II for smaller groups which are fewer than 200. So it's between 99 and 200 groups. Again, the groups have to self-nominate. And they report three to six quality measures depending upon the group size.

So it's designated for multi-specialty groups with primary care, multi-specialty without primary care or single specialty. And depending upon the specialty type the group designates, CMS can identify the set of PQRS measures pertaining to the group specialty.

So how do we start? We want to determine our eligibility, whether we're an eligible professional. We want to determine the reporting option period, are we going to use six or 12 months? Are we going to use claims or registry-based? Can we use registry-based? If we can, that's great. We want to select the measures that we're going to use. And we're going to develop a work flow based on those measures and change our policies and procedures, create staff assignments, roles or responsibilities.

And most important, educate. And that means educating our doctors because it's going to be based on our documentation that's going to be coming out of the examining room that we're going to be able to report our Physician Quality Reporting System(PQRS) measures.

Monitor, monitor, monitor. Develop a process to monitor and correct any mistakes, okay. And a couple of mistakes can mean we don't meet our 50% if we're on claims-based reporting. And if we don't monitor and we're now in October or November, we definitely would have not meet our 50th percentile. But at that point, we could go to a registry and do 80% after the fact of claim-based reporting.

So do we want to do individual versus group? Do we want to do claims versus registry? Looking at individual measures versus measure groups, we pick at least three measures versus a group measure. We look at the measure of standards and see if they apply and we use the CPT II group and we use CPT II modifiers.

We learn the frequency and time frame requirements and we ensure that our medical records, our doctor's documentation supports our reporting.

Check out the CMS cheat sheet. These questionnaires are the best. And ensure that our medical record fulfills what we're going to fill out on the questionnaires in working with our CMS PQRS Wizard.

Do we want to use claim-based or registry? Our claim-based, we're only going to have to do 50% versus 80% but we have to make sure we report it on every claim. We have to make sure we've got our quality data measure in box 24D and either a zero dollar value or a one cent dollar value in 24F. And that has to be on every claim. You can't submit it after the fact.

Registry-based, we can submit after the fact but it has to be 80% instead of 50%. And a good registry is going to scrub it for us to make sure all of our data is accurate and it's going to fulfill all Medicare guidelines and requirements before they submit it to Medicare. Our expert mentioned this in a healthcare event that you must make sure that you have a qualified registry and make sure your registry is going to provide scrubbing for you.

Get more coding updates and expert guidance on PQRS as well as precise and correct use of modifiers with AudioEducator