Frequently Asked Questions

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FAQ

By Topic: Quality Initiatives/Patient Assessment Instruments Subtopic: Physician Quality Reporting System


What is the Physician Quality Reporting System (PQRS) and how do I get started?
PQRS is a voluntary reporting program that applies a downward payment adjustment to promote the repo... (more)

What simple steps can I take to submit Physician Quality Reporting System (PQRS) quality measures data on c...
Take the following steps to begin claims-based reporting for PQRS: ... (more)

I am an eligible professional (EP) participating in the Physician Quality Reporting System (PQRS); can I in...
Yes, “incident to” billing is included in the analysis of reporting for PQRS. Claims with line items containing “i... (more)

Where do I place the Physician Quality Reporting System (PQRS) quality-data codes (QDCs) on the CMS-1500 cl...
The PQRS QDCs are HCPCS codes and reporting requirements for these codes follow current rules for reporting other HCPCS ... (more)

Why should I participate in the Physician Quality Reporting System (PQRS)?
Eligible professionals (EPs) and group practices will have the opportunity to use participation in PQRS to improve the c... (more)

What is the definition of "allowed charges" on which the Physician Quality Reporting System (PQRS) is based?
Allowed charges are the portion of the submitted charges during the reporting period that is approved for Medicare payme... (more)

Can you provide some scenarios regarding eligible professional participation in the 2016 Physician Quality ...
First, EPs should determine if they bill under more than one group practice Taxpayer Identification ... (more)

How is "place of service" (POS) analyzed for the Physician Quality Reporting System (PQRS)?
The PQRS analysis will ignore line items with POS 50 (Federally Qualified Health Center or FQHC), 72... (more)

Will CMS reject claims if we report Physician Quality Reporting System (PQRS) quality-data codes (QDCs) for...
The Medicare claims-processing system will reject claims improperly submitted to Medicare for non-Me... (more)

Is the Physician Quality Reporting System (PQRS) applicable to Medicaid patients?
While it is possible that data on Medicaid beneficiaries could be included in some PQRS reporting me... (more)

How can I be sure that my claims software will be able to successfully capture and submit all quality-data ...
Individual eligible professionals (EPs) and/or their office staff should work with their software an... (more)

Can eligible professionals participating in the Physician Quality Reporting System (PQRS) report measures f...
If a patient has an allowable Medicare Physician Fee Schedule (MPFS) Part B covered professional service, that meets the... (more)

I want to report on individual measures (NOT measures groups) through registry-based or EHR-based submissio...
An eligible professional (EP) wishing to participate in 2016 PQRS through registry-based or EHR-based submission of indi... (more)

I am a participating eligible professional (EP) reporting on Physician Quality Reporting System (PQRS) meas...
Yes. Participating EPs who bill under Medicare Part B for services provided at ASCs are included in PQRS. Applicable mea... (more)

My internal records indicate that I reported more Physician Quality Reporting System (PQRS) quality-data co...
PQRS participants should ask their billing software/clearinghouse vendor whether all QDCs were repor... (more)

Can a registry created by our practice's Electronic Health Record (EHR) participate in the Physician Qualit...
No. Although any robust office-practice EHR has "registry functionality," this is not sufficient to ... (more)

Will CMS permit more than one eligible professional (EP) to submit quality data for the same Physician Qual...
Yes. PQRS analysis is done at the provider level, not the patient level.For addi... (more)

Is the qualified registry to which I submit data required to use Physician Quality Reporting System (PQRS) ...
Yes, registries are required to use the corresponding measure specifications for each respective program year. When subm... (more)

What reporting mechanisms will there be for registries participating in the Physician Quality Reporting Sys...
Please see the Decision Trees in the PQRS Implementation Guide, available on the PQRS How to Get Started webpage. Regist... (more)

I am on the Portal and am unable to access my Physician Quality Reporting System (previously called PQRI) f...
Please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via email to ... (more)