PQRS reporting: Prepare your providers for PQRS review if reporting fewer than 9 measures

Why This Topic Matters

Quality reporting results can affect Medicare payment adjustments, so practices need to understand how reporting performance is evaluated and why documentation and claims must align with the reported measures.

Article Sections

1. Medicare review of PQRS reporting

   Introduces the purpose of Medicare’s review process for quality reporting and the general consequences of not meeting expected reporting levels.

2. Successful reporting and measure documentation

   Explains the broad concept of successful claims-based reporting and discusses how measure performance is tied to applicable encounters and patient characteristics.

3. How CMS checks reporting

   Summarizes the general review mechanics used by CMS, including the kinds of claim information and reporting elements it considers during validation.

4. Three-step MAV process

   Outlines the overall structure of the measure applicability validation review and the sequence CMS follows when evaluating reporting volume and applicability.

5. Official resources

   Lists reference materials cited at the end of the article.