PQRS and EHR Incentives: Take Advantage of the Overlap

By G.J. Verhovshek, MA, CPC

The Physician Quality Reporting System (PQRS) is a voluntary program that pays eligible professionals (EPs) (including Medicare physicians and select providers and therapists) who provide services to Medicare beneficiaries and report on approved quality measures. For 2012, the incentive equals 0.5 percent of the EP’s total estimated Medicare Physician Fee Schedule (MPFS) allowed charges for covered professional services furnished during the same reporting period.

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One of the PQRS measures overlaps with “meaningful use” incentives for physicians to adopt an electronic health record (EHR). EPs may receive incentives from both programs simultaneously. If you’re already working toward meaningful EHR adoption, you’re that much closer to collecting PQRS reimbursement, as well.

Meet PQRS and Meaningful Use Requirements with Certification

PQRS measure 124, “Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)” may be reported when an EP has adopted and used a certified, PQRS-qualified, or other acceptable EHR system.

The terms “certified,” “PQRS-qualified,” and “other acceptable” require clarification. They are not interchangeable, and only “certified” systems meet “meaningful use” requirements as well as PQRS requirements.

Per the 2012 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures:

  • A certified EHR has received certification from an authorized testing and certification body. For a list of certified EHR technology, visit the Certification Commission for Health Information Technology website (www.cchit.org/).
  • A qualified EHR has been approved by PQRS. A list of qualified EHR vendors for 2011 PQRS is available on the Centers for Medicare & Medicaid Services (CMS) website (www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AlternativeReportingMechanisms.html).

Other EHR systems that are not certified or qualified must be able to:

  • Manage a medication list
  • Manage a problem list
  • Manually enter or electronically receive, store, and display laboratory results as discrete searchable data elements
  • Meet basic privacy and security elements

Although any of the above will allow the EP to report measure 124 for PQRS, only qualified systems will meet “meaningful use” requirements.

Numerator and Denominator Reporting

All PQRS measures have a numerator and denominator. The numerator describes the action required by the measure for reporting and performance; the denominator describes eligible patients for the measure.

For measure 124, select the appropriate numerator depending on whether the EHR system the EP used to record the service was “certified” (G8447) or not (G8448).

You many use any of the codes listed in the infobox as the denominator.

A Sound Investment

You have to report more than a single performance measure to earn PQRS incentives. But, if you’re already working toward meaningful use, you’re gaining momentum to participate in PQRS, as well. The financial incentives, and the possibility of improved patient care, can only help your practice. To learn more about getting started with PQRS, visit the CMS website.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC.

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