decisionhealth Newsletters, Answer Books - 2012 Issue 4 (April)
Several ways to participate in PQRS
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Article Overview
This article explains the major ways providers could participate in CMS’s PQRS program, with emphasis on the differences between traditional claims-based reporting, measures group reporting, and registry-based submission. It places those options in the context of the MMSEA 2007 requirements and highlights the broad reporting considerations that affect eligibility, incentives, and reporting workflow. The piece is aimed at healthcare billing and coding professionals, physician practices, and others responsible for quality reporting.
Why This Topic Matters
PQRS participation affected whether eligible providers could successfully report quality measures and receive incentive payments, so understanding the available reporting pathways was important for practice compliance and quality-reporting strategy.
Article Sections
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Several ways to participate in PQRS
Introduces the CMS quality reporting options discussed in the article and distinguishes between traditional claims reporting, measures groups, and registry-based submission.
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Measures groups
Describes the concept of measures groups, how they relate to CMS quality reporting, and the general role of group-specific identifiers in claims-based reporting.
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Examples of measures groups
Provides broad examples of the kinds of conditions and services included in several measures groups and identifies their associated group identifiers.
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Example of claims-based reporting workflow
Uses a sample scenario to illustrate the general elements that may appear on claims when participating in a measures group reporting pathway.
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Other important facts to keep in mind when reporting PQRS
Summarizes additional considerations affecting PQRS reporting options, including backup participation, registry use, minimum measure reporting, and general performance comparisons.
What You Will Learn
- The overall structure of PQRS reporting options available through CMS.
- How measures groups and registry-based reporting fit within the broader PQRS program.
- What kinds of operational considerations practices needed to evaluate when selecting a reporting method.
- How PQRS reporting participation could affect incentive-payment outcomes at a general level.
Who Should Read This
- Medical coders
- Billing staff
- Quality reporting staff
- Physician practices
- Compliance professionals
- Revenue cycle professionals
Codes Discussed
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