Frequently Asked Questions

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FAQ

Are eligible professionals (EPs) working in critical access hospitals (CAHs), who bill using Method II, eligible to participate in the Physician Quality Reporting System (PQRS)?

Yes, beginning in 2014 EPs at CAHs who bill Medicare Part B using Method II can participate in PQRS (and the EHR Incentive Program) if they add their Individual NPI on the CMS-1450 Institutional Claim form (NOT the CMS-1500 form). For the 5010 version of the 837 I, Fiscal Intermediary Shared System (FISS) shall accept rendering physician/practitioner information at the line level (loop 2420A) or at the claim level if the rendering physician/practitioner is different than the attending physician/practitioner (loop 2310D).

For the 2014 PQRS program year, EPs who bill using CAH Method II will NOT be able to report via the claims-based reporting mechanism in 2014, as the claims system would have needed to be updated to pull PQRS quality-data codes (QDCs) off the 1450 claim form and only pulled off of the CMS 1500 claim form in 2014. However, EPs who bill using CAH Method II WILL be able to report PQRS via Registry, Electronic Health Record (EHR), qualified clinical data registry (QCDR), and Group Practice Reporting Option (GPRO).  

For the 2015 and 2016 PQRS program year, EPs who bill using CAH Method II WILL be able to report via the claims-based reporting mechanism as the claims system has been updated to pull PQRS quality-data codes (QDCs) off the 1450 claim form. EPs who bill using CAH Method II WILL also be able to report PQRS via Registry, Electronic Health Record (EHR), qualified clinical data registry (QCDR), and group practice reporting option (GPRO).Please refer to your Medicare Administrative Contractor (MAC) if you need assistance determining whether or not you bill Part B Medicare Physician Fee Schedule (MPFS) services.  See the Review Contractor Directory - Interactive Map.

If reporting via different mechanisms or vendors at multiple locations for one TIN, EPs must meet the PQRS satisfactory reporting requirements for each mechanism or vendor, as CMS will not combine data from multiple sources for analysis.

If you need assistance determining whether or not your provided services are included in PQRS measures, please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via qnetsupport@hcqis.org. The QualityNet Help Desk is available from 7:00 a.m. to 7:00 p.m. CTMonday through Friday.


(FAQ9952)

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