Frequently Asked Questions

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FAQ

By Topic: Physician Quality Reporting System


What is a Qualified Clinical Data Registry (QCDR) in the 2016 Physician Quality Reporting System (PQRS)?
A qualified clini... (more)

I am a surgeon participating in the Physician Quality Reporting System and have selected surgical care qual...
For 2015 and 2016, PQRS analysis will... (more)

Why does Physician Quality Reporting System (PQRS) Measure #134: Preventive Care and Screening: Screening f...
For 2016, the intent of Measure #134 has been and will remain to screen a broad range of patients fo... (more)

Does CMS use the CMS Certification Number (CCN) when analyzing data from Critical Access Hospitals (Method ...
Yes, CMS uses the CCN to 1) determine which providers should be considered an eligible professional (EP) for PQRS, ... (more)

How do I report for the 2016 Physician Quality Reporting System (PQRS) if there are fewer than 9 applicable...
For 2016 PQRS eCQMs, the expectation is that eligible professionals (EPs) or group practices reporting via the group pra... (more)

For 2016 PQRS, are the medications listed within Physician Quality Reporting System (PQRS) Measure #41: Ost...
Only the medications listed in the Measure #418 should ... (more)

Our practice (Tax Identification Number, or TIN) participated in the 2015 Physician Quality Reporting Syste...
... (more)

What is meant by "unique" patients or events in the Physician Quality Reporting System(PQRS)?
For individual eligible professionals (EPs) participating in PQRS, unique is in the context of regis... (more)

For the Physician Quality Reporting System (PQRS), will physicians' and other eligible professionals' (EPs)...
Individual EPs report data to CMS at the TIN/NPI level, while PQR... (more)

We are a 2016 Physician Quality Reporting System (PQRS) group practice reporting via registry and participa...
Yes, reporting CAHPS would fulfill the PQRS cross-cutting me... (more)

Where can I find transition and timeline information for both programs as Physician Quality Reporting Syste...
... (more)

Are eligible professionals (EPs) working in critical access hospitals (CAHs), who bill using Method II, eli...
Yes, beginning in 2014 EPs at CAHs who bill Medicare Part B ... (more)

What is the Enterprise Identity Management (EIDM) system and how does it relate to the Physician Quality Re...
EIDM is the acronym ... (more)

When is the cut-off for Physician Quality Reporting System (PQRS) claims data submission?
The Tax Relief and Health Care Act of 2006 (TRHCA) permits a two-month data submission period for cl... (more)

I am an employee member of a group practice and I have assigned my Medicare Part B physician billing to the...
If a professional has assigned Medicare Physician Fee Schedule (MPFS) billing to an employer, the el... (more)

Is there a list of vendors approved to administer the CAHPS for 2016 Physician Quality Reporting System (PQ...
A list of approved vendors can be found on the CAHPS for PQRS website. For technical assistance and information, contact... (more)

Is there an appeals process if I do not pass Physician Quality Reporting System (PQRS) measure-applicabilit...
Eligible professionals (EPs) and group practices can request an informal review of their PQRS data, which may include q... (more)

Will each individual eligible professional (EP) and group practice who participates in the Physician Qualit...
Yes. CMS will provide confidential PQRS feedback reports in the fall of 2016, following the end of the PQRS reporting pe... (more)

What is CMS EIDM?
EIDM is the acronym for CMS' Enterprise Identity Management system, which provides a way for business partners to apply ... (more)

Are Medicare providers under critical access hospitals (CAHs), who have reassigned their billing rights to ...
... (more)

Are registries able to submit National Provider Identifiers (NPIs) for group practices participating via th...
For 2014 PQRS GPRO registry submission, if a registry submits xml data on behalf of a group practice and the 10-digit NP... (more)

Why am I no longer seeing N365 on my Remittance Advice codes for Physician Quality Reporting System (PQRS) ...
Effective on 7/1/2014, EPs who bill on a $0.00 QDC line item will receive the N620 code. It replaces the current N365, w... (more)

What is an informal review?
An informal review is the process that allows individual eligible professionals (EPs), CPC practice sites, PQRS group pr... (more)

Why does it take six to eight months to receive feedback reports for the Physician Quality Reporting System...
The PQRS feedback reports are dependent on the time it takes to process and analyze the data and we understand provider ... (more)

How are a group practice’s patients identified and sampled for the CAHPS for 2014 Physician Quality Repor...
CMS will identify... (more)

We are a specialty large group practice (100+ eligible professionals [EPs]) interested in reporting Physici...
CMS recommends that each potential group practice review all of the measures included within the 2016 GPRO Web Interface... (more)

Is registering for an Enterprise Identity Management (EIDM) account required to participate in the Physicia...
Registering for an EIDM account is not required for eligible professionals to submit PQRS quality data via claims, regis... (more)

I am an eligible professional (EP) choosing to report on 2016 Physician Quality Reporting System (PQRS) mea...
If EPs choose to report measures groups via registry, a minimum of 11 denominator-eligible patients must be Medicare Par... (more)

Where can I find information about the ICD-10-CM code updates that impact PQRS quality reporting on the CMS...
P... (more)

Do I need to register to obtain an Enterprise Identity Management system (EIDM) account?
If you did not have an Individuals Authorized Access to CMS ... (more)

How will my 2015 and/or 2016 Physician Quality Reporting System (PQRS) results be determined if I report us...
CMS will review PQRS data submitted via one or more reporting mechanisms to determine satisfactory reporting for avoidin... (more)

For 2016, is it acceptable for group practices participating in the Physician Quality Reporting System (PQR...
Yes, PQRS group practices may also report using mechanisms other than what was s... (more)

Can eligible professionals (EPs) billing under Critical Access Hospitals Method II (CAH IIs) participate in...
Yes, a group practice can participate in PQRS via GPRO regardless of whether or not the group has EPs that bill under CA... (more)

How does CMS verify that my quality reporting submission is for both the Medicare EHR Incentive Program and...
Qualified Clinical Data Registries (QCDRs), Data Submission Vendors and eligible professionals (EPs)... (more)

When does CMS plan to release the 2017 electronic Clinical Quality Measures (eCQMs) value set addendum?
All changes to the eCQM value sets will be available through the National Library of Medicine’s Value Set Authority Ce... (more)

Who should I contact if I have questions about the Physician Quality Reporting System (PQRS)?
If you have questions, please contact the QualityNet Hel... (more)

What survey meets CMS’ participation requirements for the 2014 Physician Quality Reporting System (PQRS)?
CMS will use the CAHPS for PQRS survey to measure patient experience with group practices participating in the group pra... (more)

How will benchmarking be applied to practices reporting via Qualified Clinical Data Registries (QCDRs) for ...
To the extent that individual eligible professionals (EPs) and TINS are repor... (more)

Are there Physician Quality Reporting System (PQRS) consultants?
Some industry sources are positioning... (more)

Why does CMS reference 2017 PQRS payment adjustments when the 2016 reporting period affects 2018 PQRS payme...
The 2017 payment adjustment reference is included because eligible professionals (EPs) that participated in a Medicare S... (more)

Is it possible for a group practice to cancel its registration (made in the Physician Value-Physician Quali...
Yes. Group practi... (more)

Do we still need to report 2016 PQRS measures if we believe we are unable to satisfactorily report the meas...
CMS expects individual eligible professionals (EPs) and group practices to still report quality measures for 2016 PQRS m... (more)

Can I use my Accountable Care Organization's (ACO's) claims data to satisfy CMS web interface reporting?
Yes, but only in very limited circumstances, specifically, when CMS has prepopulated Prev 7/ACO 14, ... (more)

When reporting via the Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO), ar...
Yes. As long as the EP has reassigned his/her billing rights to the new group practice's Tax Identif... (more)

Is there a user guide for CMS’ Enterprise Identity Management (EIDM) system?
CMS Quick Reference or User Guides are available by accessing the ... (more)

For 2016 Measures Group reporting, if an eligible professional (EP) has less than a 20 patient sample due t...
Y... (more)

Can I use my Accountable Care Organization’s (ACO’s) claims data to submit documentation for a quality ...
No. Documentation must come from the beneficiary’s medical record and document... (more)

Which 2016 PQRS measures were impacted by changes to ICD-10-CM codes in the 4th Quarter of 2016?
The majority of ICD-10-CM coding changes that impacted 2016 PQRS measures were related to diabetes, pregnancy, cardiovas... (more)

Will Physician Quality Reporting System (PQRS) results be publicly reported?
CMS will publish PQRS quality information such as participation and reporti... (more)

For 2016 PQRS, what happens if the eligible professional (EP) chooses a different reporting mechanism becau...
EPs rep... (more)

What is the process for determining which group practices or eligible professionals (EPs) are negatively im...
CMS will perform an analysis after the close of the 2016 PQRS reporting period and CMS will review the submissions to de... (more)

We received a listserv message that says the Value Modifier program will consider solo practitioners and gr...
T... (more)

Should Quality Reporting Document Architecture (QRDA) files submitted to the PY 2016 Physician Quality Repo...
Qualified Clinical Data Registries (QCDRs), Data Submission Vendors and eligible professionals (EPs) reporting via the E... (more)

Does CMS plan to communicate to group practices and eligible professionals (EPs) that were affected by the ...
CMS is assessing the ... (more)

What will you do with my personally identifiable information (PII) when registering for an Enterprise Ident...
EIDM uses an external authentication service provider, Experian, to help us verify your identity based on the informatio... (more)

Why should I submit personal information at the time of registering for an Enterprise Identity Management s...
EIDM collects personal information to uniquely identify the user registering with the system. We may also use your answe... (more)

Will my Social Security Number (SSN) be shared with any federal or private agency when registering for an E...
Your SSN will be used for verification purposes only. EIDM does not share your SSN with any other federal or private age... (more)

We were informed of the listserv message related to ICD-10-CM updates. If my individual eligible profession...
If it is found that the individual EP or group practice failed to satisfactorily report for 2016 PQRS solely because of ... (more)

For 2016 PQRS, can eligible professionals or group practices report on ICD-9-CM codes?
The coding as defined... (more)

As a Physician Quality Reporting System (PQRS) participant or vendor, why do I need an Enterprise Identity ...
EIDM accounts are required for participants to obtain feedback reports and for vendors to submit dat... (more)

Due to the pending administration change, does CMS anticipate an impact to 2016 PQRS reporting requirements?
At this time, CMS does not anticipate changes to the 2016 PQRS reporting requirements due to administration changes. Eli... (more)