decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 7 (July)
Quality reporting: Conduct a mid-year check to make sure you’re on target for PQRS success
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Article Overview
This article explains why a mid-year PQRS checkup matters for practices that report quality measures to CMS. It reviews broad compliance and workflow topics such as measure specifications, provider-specific fit, claims-based reporting, registry use, remittance review, and the relationship between PQRS and the later MIPS transition. The piece is aimed at physicians, non-physician practitioners, practice managers, coders, and compliance staff responsible for quality reporting performance.
Why This Topic Matters
PQRS performance can affect reimbursement and penalty exposure, so practices need an early review of reporting processes to avoid end-of-year problems. The article is relevant to organizations that submit quality data through claims or registries and want to verify that their reporting methods, staffing, and documentation workflows are still working.
Article Sections
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PQRS mid-year readiness and penalty risk
Introduces the importance of checking quality reporting progress midway through the year and summarizes the broader CMS program context. It frames the article around practice readiness and the risk of falling behind on reporting obligations.
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Review your quality game plan
Covers the need to confirm that reported measures still match the practice’s current workflow and that collection and submission methods remain aligned with measure specifications. It also discusses common implementation issues that can interrupt reporting.
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Follow 4 steps to check your PQRS reporting
Outlines a practical review of provider fit, information capture, registry planning, claims-based submission, and remittance follow-up. The section focuses on evaluating whether the practice’s reporting process is functioning as expected.
What You Will Learn
- Why a mid-year PQRS review can help practices stay on track
- What broad areas of a quality reporting workflow should be reviewed during the year
- How measure selection, data capture, and submission methods affect reporting readiness
- What CMS-related follow-up materials can be reviewed after submission
- How registry-based and claims-based reporting differ at a high level
Who Should Read This
- Physicians
- Non-physician practitioners
- Practice managers
- Medical coders
- Compliance auditors
- Quality reporting staff
Codes Discussed
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