Three New Educational Resources for 2011 PQRS

The Centers for Medicare & Medicaid Services (CMS) announced on July 6 three new fact sheets for the 2011 Physician Quality Reporting System (PQRS):

  • Physician Quality Reporting System: Satisfactorily Reporting 2011 Physician Quality Reporting System Measures – Claims and Registry Fact Sheet
  • 2011 Physician Quality Reporting System Made Simple for Reporting the Preventive Care Measures Group Fact Sheet
  • Physician Quality Reporting System: (Physician Quality Reporting, formerly called Physician Quality Reporting Initiative or PQRI) Reporting Periods for 2011 Fact Sheet

Satisfactorily Reporting 2011 Measures – Claims and Registry

This fact sheet provides step-by-step advice on how to get started correctly reporting using PQRS, and offers tips for physician quality reporting to assist eligible professionals and their staff to submit Physician Quality Reporting measures accurately, as well as for claims-based reporting for individual measures and measures groups. Among notable information was the common reporting errors associated with claims-based reporting, which are:

  • No QDC submitted on an eligible claim. Failure to submit a QDC on claims for eligible.
  • Medicare patients will result in a “missed” reporting opportunity that can impact incentive eligibility.
  • Eligible claim without an individual NPI or with the NPI incorrectly placed on the claim will result in a claim rejection by the carrier/MAC and will not be included in Physician Quality Reporting analysis.
  • Eligible claim submitted as a QDC-only claim (no denominator information is accompanied).
  • QDC submitted on a denominator-ineligible claim for the Physician Quality Reporting measure:
    • Diagnosis is incorrect on claim for measure reported;
    • Encounter code is incorrect on claim for measure reported; or
    • Age/gender on claim is incorrect for measure reported.
  • Billing software does not allow enough lines on the claim and splits the claim. CMS will reconnect split claims before Physician Quality Reporting System analysis.

2011 Physician Quality Reporting System Made Simple for Reporting the Preventive Care Measures Group

This fact sheet explains who should report using the Preventive Care Measures Group and how to get started. You can get started on reporting the Preventive Care Measures Group for 30 unique Medicare Part B FFS patients between Jan. 1, 2011 and Dec. 31, 2011 by:

  • Selecting a start date to begin submitting quality data (e.g., Feb. 15, 2011);
  • Identifying the next Medicare Part B FFS patient you will be seeing who is 50 years of age or older and for whom you will bill an evaluation and management (E/M) CPT® code in the ranges of 99201-99205 or 99212-99215. No specific ICD-9-CM diagnosis is required for this measures group;
  • Reporting the measures group specific intent G code (G8486 I intend to report the preventive care measures group) with your first patient; and
  • Referring to Table 1: Preventive Measures Group Demographic Criteria on the fact sheet to see which measures apply to the patient based on the patient’s age and gender.

There also is information about:

  • how to report using the Preventive Care Measures Group;
  • using the Data Collection Worksheet to track your 30 patients; and,
  • how to fill out the CMS-1500 claim form using two sample form examples in Appendix B.

Physician Quality Reporting, formerly called Physician Quality Reporting Initiative (PQRI) Reporting Periods for 2011

This fact sheet explains the two reporting periods for 2011 as:

  • 12-month (Jan. 1, 2011 – Dec. 31, 2011); and
  • 6-month (July 1, 2011 – Dec. 31, 2011).

The reporting period options provided in the “2011 Physician Quality Reporting System Implementation Guide,” Appendix C, page 24, are:

  • Claims-based reporting of individual measures for 50 percent or more of an eligible professional’s applicable Medicare Part B Fee-For-Service (FFS) patients for at least 3 individual measures, or on each measure if less than 3 measures apply (July 1, 2011 – December 31, 2011);
  • Claims-based reporting of one measures group for 50 percent or more of an eligible professional’s applicable Medicare Part B FFS patients for the measures group (with a minimum of 8 patients) (July 1, 2011 – December 31, 2011);
  • Registry-based reporting of at least 3 individual measures for 80 percent or more of an eligible professional’s applicable Medicare Part B FFS patients for the measures (July 1, 2011 – December 31, 2011); and
  • Registry-based reporting of one measures group for 80 percent or more of an eligible professional’s applicable Medicare Part B FFS patients for the measures group (with a minimum of 8 patients) (July 1, 2011 – December 31, 2011).

You can find these PQRS fact sheets and other PQRS resources on the CMS website on the “Educational Resources” tab.

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