PQRS - Frequently Asked Questions
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PQRSwizard® FAQs

What is the Physician Quality Reporting System (PQRS)?

PQRS (formerly PQRI) was developed by CMS in 2007 as a voluntary pay-for-reporting program that provided a financial incentive to physicians and other eligible professionals who report data on quality measures for covered services furnished to Medicare beneficiaries. For more information about PQRS, you can access the CMS website at http://www.cms.gov/PQRS.

What is the incentive and penalty schedule?

There is no PQRS incentive for the current reporting period (Calendar Year 2015). Eligible professionals who do not satisfactorily report data on quality measures for covered professional services will incur a downward payment adjustment. The PQRS payment adjustment applies to all of the eligible professional’s Part B covered professional services under the Medicare Physician Fee Schedule (PFS). Reporting during the 2015 PQRS program year will be used to determine whether a 2.0% penalty applies in 2017.

 

I have not coded PQRS codes into my claims for 2015, can I still participate?

 

You can report through the PQRSwizard – PQRSwizard utilizes the registry-based approach to PQRS reporting. Because of this, you can report your patients to the registry, without coding your claims! You can report patients from encounters earlier in 2015, as well as prospective 2015 encounters.

 

I have been submitting PQRS data through my claims or to another registry. Can I switch to PQRSwizard?

YES! If you would like to switch to PQRSwizard, you can certainly do so. CMS will review and analyze each of your submissions independently and will use the submission that is most advantageous to you.

 

What measures are available through PQRSwizard?

PQRSwizard offers Measures Groups as well as Individual Measures. Visit the PQRSwizard Products Page to see what is available for 2015 reporting.

 

Which measures should I report?

It is recommended that you choose measures that apply to a significant portion of your patient population. PQRSwizard includes a measures selection guide to help you select the appropriate measures. It's important to note that a 0% performance rate for any one measure reported will result in ineligibility. PQRSwizard will prompt you to enter additional patients should this scenario occur.

 

What if I do not see measures that are applicable to my practice?

If you don't see any measures that can be applied to your patient population (see question above), then you may wish to contact CMS to determine how best to proceed.

 

How much time will it take me to complete my PQRS reporting using PQRSwizard?

The answer to this question largely depends on your accessibility to patients and information about their treatments. PQRSwizard's approach is designed to reduce the amount of time and subsequent reporting errors that may occur when reporting PQRS measures. Many users of the PQRSwizard have completed their report in just a few hours.

 

Do I have to register for each practitioner?

Yes. PQRS reporting is calculated using your NPI and TIN combination. The NPI and TIN combination that you provide during registration will be used by CMS to determine your eligibility for PQRS reporting. If CMS determines that your reporting is eligible, your feedback will be based on the allowed Medicare Part B FFS charges billed in 2015 through the NPI and TIN combination that you provide to PQRSwizard. If you need to register multiple NPI and TIN combinations, then each additional combination will require a new PQRSwizard account registration and report submission. If you are reporting a Self-Nominated GPRO organization, each GPRO TIN must register a separate account. If you need to register multiple GPRO Tax IDs, each TIN will require a new account registration and report submission.

 

There are multiple practitioners in my practice, which are eligible for the reporting program?

PQRS is intended for physicians, therapists, and other practitioners that would ordinarily submit claims to Medicare Part B. To see the full list of eligible professionals, visit this link: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_List_of_Eligible_Professionals.pdf

 

How many patients do I need to report? Does it matter which ones I choose?

There are different requirements for reporting on Measures Groups versus Individual Measures.

  • For Measures Groups reporting, CMS requires that you report on twenty (20) patients that are eligible for the Measures Group. You must have a minimum of 11 Medicare Part B Fee-For-Service (FFS) within your 20-patient sample, and the remaining patients may be non-Medicare.
  • For Individual Measures reporting, you must report on 50% of your Medicare Part B FFS patients that are eligible for a minimum of nine individual measures across 3 National Quality Strategy (NQS) Domains. All patients reported must have been seen during the 2015 calendar year.

How do I know that I've completed the process?

The PQRSwizard "Progress Monitor" will visually display the requirements and track the number of eligible patients entered based on the measures selected. Once you have met the requirements, the PQRSwizard will indicate that your report is complete and allow you to submit your report. Until you meet the requirements, you will not be able to submit your report.

 

I have entered all of my data and submitted my PQRS report through PQRSwizard. When will I receive feedback?

CMS has not provided specific information as to when the 2015 feedback will be issued. However, based on previous years, it's likely that the 2015 feedback will be issued by the fall of 2016. For more information about your feedback and prior years' incentive payments, contact the CMS PQRS Help Desk.

 

How will my 2014 incentive be paid?

If you currently receive your claim payments from Medicare electronically, then your PQRS incentive payment will be paid electronically to the same account. (For 2009, such payments were documented on your Medicare electronic remittance advice with a code of PQ09 and the indicator LE.) 

If you currently receive your claim payments from Medicare on a paper check, then your PQRS incentive payment will also be paid by paper check. That check will be mailed to the address associated with the Tax ID Number and NPI in the National Plan and Provider Enumeration System (NPPES) system. If that address is incorrect or has been changed, you will need to update the address with NPPES (
https://nppes.cms.hhs.gov).

 

How can I contact the CMS PQRS Help Desk?

Your PQRS-related questions can be addressed to the QualityNet Help Desk, 7:00 AM – 7:00 PM CST. You can reach the QualityNet Help Desk by phone: 1-866-288-8912, or Email: qnetsupport@hcqis.org.

 

How do I select between Measures Groups and Individual Measures?

Review the available Measure Groups and Sets of Individual Measures within the PQRSwizard Product Selection Guide, as it is recommended that you choose measures that apply to a significant portion of your patient population. It's important to note that a 0% performance rate for any one measure reported will result in incentive ineligibility. 

To select the method that fits your practice best, review the required sample of patients, eligible denominator information such as diagnosis code and encounter/procedure code, and select the method that is most applicable to your practice.

 

How do I report Individual Measures?

Report at least 9 measures covering at least 3 of the NQS domains, OR, if less than 9 measures covering at least 3 NQS domains apply to the eligible professional, report 1—8 measures covering 1-3 NQS domains for which there is Medicare patient data, AND report each measure for at least 50% of the eligible professional's Medicare Part B FFS patients seen during the reporting period to which the measure applies. Providers who see Medicare Patients in a face-to-face encounter must also report at least one Cross-Cutting Measure. Measures with a 0% performance rate would not be counted. 

For an eligible professional who reports fewer than 9 measures covering 3 NQS domains via the registry-based reporting mechanism, the eligible professional will be subject to the MAV process, which would allow CMS to determine whether an eligible professional should have reported on additional measures and/or measures covering additional NQS domains.

 

How do I report Measures Groups?

Report at least 1 Measures Group, AND report each measures group for at least 20 patients, a majority of which must be Medicare Part B FFS patients. To select a Measures Group, see the Products section of the PQRSwizard website and select "Measures Groups".

 

What is MAV?

The PQRS Measure Applicability Validation Process, or MAV, is the validation process for 2015 PQRS eligibility and payment adjustment for eligible professionals or GPRO group practices who satisfactorily submit quality data for fewer than 9 PQRS measures across 3 domains or 9 or more PQRS measures across less than 3 domains. The MAV process will determine whether those professionals should have submitted additional measures or additional measures with additional domains. 

Eligible Professionals or group practices with a specialty that has less than 9 measures or less than 3 domains would be subject to MAV but could still be eligible for reporting and avoid the payment adjustment. For payment adjustment considerations, those eligible professionals or group practices who satisfactorily submit quality data for fewer than three PQRS measures, the MAV process will determine whether an eligible professional or group practice should have submitted for additional measures. 

Eligible professionals or group practices who fail MAV may be subject to the 2017 Payment Adjustment.

Additional information regarding the PQRS Payment Adjustment can be located here (
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS).

 

What is GPRO?

This reporting option requires the submission of one PQRS report per TIN for the designated reporting period. Group practices with 2 or more eligible professionals may elect this option. Groups can register to participate in the 2015 PQRS GPRO via the Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System between April 1, 2015 and June 30, 2015 (11:59 pm EDT). The Registration System can be accessed at https://portal.cms.gov using a valid Individuals Authorized Access to the CMS Computer Services (IACS) account.

  • Report at least 9 measures covering at least 3 of the NQS domains, OR, if less than 9 measures covering at least 3 NQS domains apply to the group practice, report 1—8 measures covering 1-3 NQS domains for which there is Medicare patient data, AND report each measure for at least 50 percent of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Practices who see Medicare Patients in a face-to-face encounter must also report at least one Cross-Cutting Measure. Measures with a 0 percent performance rate would not be counted.
  • For a group practice who reports fewer than 9 measures covering at least 3 NQS domains via the registry-based reporting mechanism, the group practice will be subject to the MAV process, which would allow CMS to determine whether a group practice should have reported on additional measures and/or measures covering additional NQS domains.
  • Note: Measure group reporting is not permitted when reporting as a GPRO.
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