Claims Reporting

Providers may report either of the following via claims:

• Three individual measures for 50% of your Medicare Part B pay-for-service (PFS) patients seen in 2012.
• One Measures Group for at least 30 Medicare Part B pay-for-service patients seen in 2012.

Measures and measures groups with a zero percent performance rate will not be counted in 2012.

• For Individual PQRS measures: “2012 Physician Quality Reporting System Measure List and Implementation Guide”
• For Measures Groups: “2012 Physician Quality Reporting System Measure Groups Specifications and Release Notes, Getting Started with 2012 Measures Groups, 2012 Quality-Data Code Categories and 2012 Groups Single Source Code Master”

Select measures applicable to your practice. Download the measure specifications; make sure you thoroughly understand the reporting requirements. Specifications for individually-reported measures may differ from similar measures reported as part of a Measures Group.

Primaris can assist with PQRS measures related to preventive and cardiac care — contact us for details.

If your software has the capability, turn-on alerts/flags to help identify eligible PQRS patients as they are seen. Many vendors have pre-defined alerts that align with PQRS measures. If flags can’t be set electronically, determine another method to alert providers.

Record the correct diagnosis, CPT, and Quality Data Codes (QDC) for each measure on the patient bill and submit the bill as usual.

QDCs should be submitted on the line item as a zero charge, or with a nominal amount if billing software does not permit a zero charge line item. The charge field cannot be left blank. QDCs will be denied and then passed on for PQRS analysis and payment. You will see a denial code N365 on the Remittance Advice. This code does not mean the data was submitted correctly, only that it was passed on for PQRS analysis. You cannot submit a bill for the sole purpose of PQRS reporting or to correct a PQRS code.

If possible, track your performance by running monthly reports for each of the measures from your Practice Management or EHR software. Your I.T consultant may be able to schedule a task to automatically run the reports on the same day every month. Identify patients who do not meet the measure. Discuss results among staff and physicians, possibly at monthly meetings, and establish a plan and process for improvement.