decisionhealth Newsletters, Part B News - 2016 Issue 6 (June)
Conduct a mid-year check to make sure you’re on target for PQRS success
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Article Overview
This article is for practices and coders who need to confirm that year-to-date quality reporting remains on track under PQRS. It explains the kinds of mid-year review activities that matter most, including checking measure specifications, matching measures to clinician roles, verifying data capture workflows, evaluating registry options, and confirming that claims-based reporting is being submitted as intended. The discussion is framed around CMS quality reporting requirements and the operational steps practices should monitor to avoid late-year problems.
Why This Topic Matters
Mid-year review can help a practice identify reporting gaps early, while there is still time to correct workflow problems, registry issues, or claims-based submission errors. That matters because missed quality reporting can affect reimbursement and create avoidable administrative burden later in the year.
Article Sections
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Quality reporting
Introduces the mid-year quality-reporting review and the broader CMS program context. It frames the importance of checking whether reporting activities remain on track.
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Remember the 50/50 requirement
Summarizes the participation threshold discussed in the article and the types of providers affected. It emphasizes the need to confirm that reporting performance is still meeting program expectations.
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Review your quality game plan
Covers practical mid-year self-assessment topics such as measure specifications, workflow reliability, registry planning, and claims-based submission review. It also references remittance review and related CMS quality-reporting indicators.
What You Will Learn
- How to review a practice’s quality-reporting status mid-year
- How to assess whether reported measures still fit provider workflows
- How to evaluate registry-based and claims-based reporting processes
- How to check whether data capture and submission steps are functioning consistently
- How to monitor CMS-related reporting indicators at a high level
Who Should Read This
- Physician practices
- Medical coders
- Compliance auditors
- Quality reporting staff
- Practice administrators
Codes Discussed
Modifiers Discussed
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