PQRS Reporting 2016: What You Need to Be Familiar With

PQRS or Physician Quality Reporting System 2016 is a health care quality improvement incentive program by the CMS, which is an exemplary ‘Pay for Performance’ program. The PQRS 2016 can be better understood by the individual EPs and PQRS group practices, of all knowledge level upon being familiar with the following aspects.

Especially, the 2016 Beginner Reporter Toolkit, a fresher level toolkit does have a couple of documents for the better reference of individual EPs and PQRS group practices, regarding the different PQRS decision terms and the effect of quality reporting.

PQRS Reporting 2016

You can learn about reporting through “Quality Reporting Roadmap” and about the way the information you put is used with the “Take a Moment & Participate Flowchart.”

The qualified professionals taking part in other Medicare quality programs should go through the following steps to have a better understanding on how to report for 2016 Medicare Quality Reporting Programs.

Step 1:

It is important first to make surewhether you are eligible to take part in PQRS reporting 2016 to stay free from the 2018 negative payment adjustment. You can check your eligibility through 2016 PQRS list of eligible professionals at CMS website.

Step 2:

It is important to make sure whether you are interested in PQRS as an individual EP or as a member of a group practice. Individual EPs are recognized on claims through their NPI (National Provider Identifier) and TIN number. Group practices can take part in PQRS by registering through the Group Practice Reporting Option (GPRO) to be analysed at the TIN level. It is important to note that the group practices taking part through GPRO can be referred to as PQRS group practices.

Step 3:

Now you have to choose your reporting mechanism among various reporting mechanisms, according to whether you are a part of PQRS as an individual EP or as a part of a PQRS group practice.

Step 4:

Individual EPs and PQRS group practices need to pick a minimum of 9 individual measures fulfilling 3 Nation Quality Strategy (NQS) domains or 1 measures group as a way to report on measures to CMS (with the exception of GPRO Web Interface). Individual EPs or PQRS group practices also do need to report a cross-cutting measure, once they do have a minimum of one Medicare patient with a one-to-one interaction (along the exception of the QCDR reporting mechanism).

To find out which measures are appropriate for the specific reporting mechanism, one can refer to the “2016 PQRS Measures List” and the PQRS Web-Based Measure Search Tool on the PQRS Measures Codes webpage.

Step 5:

Individual EPs and PQRS group practices those don’t report data on quality measures for included professional services have been subjected to a negative payment adjustment under PQRS since last year. You can have complete detail on payment adjustment through the PQRS Payment Adjustment website, regarding the ways of avoiding PQRS payment adjustments in future. The negative payment adjustment is applicable for the whole of the individual EP’s or PQRS group practice’s Part B fulfilled professional services under the Medicare Physician Fee Schedule (MPFS).

Step 6:

You need to go through the PQRS timeline (2015 to 2018) to have the details of important dates regarding PQRS.

CMS qualified PQRS registry for year 2016 can be found here.

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