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How To Get Started

Step-by-Step Instruction in Getting Started with the Physician Quality Reporting System (PQRS)

Note: For guidance on how to report once across Medicare quality reporting programs (PQRS, EHR Incentive Program, Value-based Modifier, and Accountable Care Organizations), please see How to Report Once for 2014 Medicare Quality Reporting Programs.

STEP 1:

Determine if you are eligible to participate for purposes of the PQRS incentive payment and payment adjustment. A list of eligible medical care professionals considered eligible to participate in PQRS is available. Read this list carefully, as not all entities are considered “eligible professionals because they are reimbursed by Medicare under other fee schedule methods than the Physician Fee Schedule (PFS).

STEP 2:

Determine which PQRS reporting method best fits your practice. PQRS has several methods in which measure data can be reported. An eligible professional may choose from the following methods to submit data to CMS: claims-based, registry-based, qualified Electronic Health Record (EHR), Qualified Clinical  Data Registry (QCDR) or the Group Practice Reporting Option (GPRO).

In order to satisfactorily report, it is important to review each method’s specific reporting criteria. For additional guidance, refer to the 2014 Physician Quality Reporting System Implementation Guide.

STEP 3:

If the chosen method to report is qualified registry-based, determine which measure reporting option (individual measures or measures group) best fits your practice. Review the specific criteria for the chosen reporting option in order to satisfactorily report.  

Eligible professionals who choose to report 2014 PQRS individual measures should select at least nine clinically applicable measures across three National Quality Strategy (NQS) domains to submit in an attempt to qualify for a PQRS incentive payment. If fewer than nine measures or if less than three NQS domains are reported via claims or qualified registry, CMS will apply a measure-applicability validation (MAV) process when determining incentive eligibility. Refer to MAV information available on the Analysis and Payment page, claims-based MAV on the Measures Codes page and registry-based MAV on the Registry Reporting page.  

All PQRS measures and their available reporting methods can be reviewed in the 2014 Physician Quality Reporting System (PQRS) Measures List.  The list is available in the 
2014 PQRS Measure List Implementation Guide
zip file.

STEP 4:

Individual Measures or Measures Group

Eligible professionals may choose at least nine individual measures across three NQS domains or one measures group as an option to report on measures to CMS. Review the following supporting documentation for specific criteria to satisfactorily report on these two options.

If already participating in PQRS, there is no requirement to select new/different measures for the 2014 PQRS. NOTE: All PQRS measure specifications are annually updated and posted prior to the beginning of each program year; therefore, eligible professionals will need to review them for any revisions or measure retirement for the current program year.

Notice that each measure or measure group has a reporting frequency or timeframe requirement for each eligible patient seen during the reporting period by each individual eligible professional (NPI). The reporting frequency (i.e., report each visit, once during the reporting period, each episode, etc.) is found in the instructions section of each measure specification or in the Measure Group Overview section. Ensure that all members of the team understand and capture this information in the patients’ medical record to facilitate reporting.

Individual Measures 

The following documents can be found on the Measure Codes section page or by clicking on the following: 2014 PQRS Individual Claims Registry Measure Specification Supporting Documents zip file and the 2014 PQRS Measure List Implementation Guide zip file:

  1. 2014 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Individual Claims and Registry Reporting and Release Notes for instructions on how to report claims-based or registry-based individual measures. Just print the pages for the measure specifications you are reporting as the document is very lengthy.
  2. 2014 Physician Quality Reporting System (PQRS) Implementation Guide which describes important reporting principles for all methods of PQRS reporting and includes Decision Trees on reporting for incentive as well as avoiding the payment adjustment.      

Measures Groups

The following documents can be found on the Measure Codes section page or by clicking on the 2014 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2014 PQRS Measures Groups, 2014 Quality-Data Code Categories, and 2014 PQRS Measures Groups Single Source Code Master zip file:

  1. 2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual and Release Notes, for registry-based reporting of measures groups. Just print the pages for the measure specifications, including the measure group denominator coding, you are reporting. Note that the specifications for a measures group are different from those for individual measures because they identify a common denominator across the measures group. Be sure you use the correct specifications.
  2. Getting Started with 2014 Physician Quality Reporting System (PQRS) Measures Groups is the implementation guide for reporting measures groups.
    • For 2014, PQRS measure groups are reportable via registry only.

As you read the specifications and reporting instructions, you will notice that each of the measures has a Quality-Data Code (QDC) (a Current Procedural Terminology [CPT] II code or G-code) associated with it. Note that several measures allow the use of CPT II modifiers: 1P, 2P, 3P, and the 8P reporting modifier. Only allowable CPT II modifiers may be used with a CPT II code. Eligible professionals should use the 8P reporting modifier judiciously for applicable measures they have selected to report. The 8P modifier may not be used indiscriminately in an attempt to meet satisfactory reporting criteria without regard toward meeting the practice's quality improvement goals.

To qualify for the incentive, the correct numerator QDC must be reported on at least 50 percent of the eligible instances if reporting via claims or registry for each selected measure. A claim is considered "eligible" in PQRS when the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and/or the CPT Category I service codes on the claim match the applicable diagnosis and encounter codes listed in the denominator criteria of the measure specification.

Refer to the 2014 Physician Quality Reporting System (PQRS) Quality-Data Code Categories for a complete list of how each code will be used to calculate performance rates by clicking on the 2014 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2014 PQRS Measures Groups, 2014 Quality-Data Code Categories, and 2014 PQRS Measures Groups Single Source Code Master zip file:. 

STEP 5:

Review information on the PQRS Payment Adjustment. To avoid being subject to a future PQRS payment adjustment, individual EPs can:

• Meet the requirements for satisfactory reporting or satisfactory participation in the 2014 PQRS, or
• Report 1-2 individual measures across at least 1 National Quality Strategy (NQS) domain via claims or registry on 50% or more of applicable Medicare Part B FFS patients across applicable domains.  Refer to the Payment Adjustment Information section on this website for complete information on how to avoid future PQRS payment adjustments.

Note: “Satisfactory reporting” refers to participating in PQRS to earn the incentive payment (and avoid the 2016 payment adjustment) while “satisfactory participation” refers to EPs participating in the new “qualified clinical data registry” reporting option for 2014.

Need Assistance?

Contact the QualityNet Help Desk for help with:

  • General CMS PQRS & eRx information
  • PQRS Portal password issues
  • PQRS/eRx feedback report availability and access
  • PQRS-IACS registration questions
  • PQRS-IACS login issues

Monday – Friday; 7:00 a.m.–7:00 p.m. CST

Phone: 1-866-288-8912

TTY: 1-877-715-6222

Email: Qnetsupport@hcqis.org

Frequently Asked Questions (FAQs)

Visit our Physician Quality Reporting System FAQ page and enter keywords in the search box to find answers on "How do I get started" or any other area of the program you may have questions about.

To view all of the 2014 PQRS Program Requirements, review the 2014 Medicare Physician Fee Schedule Final Rule.

PQRS Listserv

Stay informed about the latest PQRS news by subscribing to the PQRS Listserv.