Five Common Pitfalls you Should be Arare of While Using PQRS

Whether you are new to CMS's Physician Quality Reporting System program or you have been gathering bonuses from it for a while, you can use some tips on ways to stay away from common PQRS mistakes. CMS representatives throw light on these issues and shared the following information about the five most common PQRS pitfalls.

Missing your suitable population. When you are opting for measures to report, you should carefully review all ICD-9-CM diagnoses and CPT service codes that'll qualify claims for inclusion in physician quality reporting measurement calculations.

Remember that some measures have specified patient demographics that must be met prior to reporting them such as age or gender parameters.

For those measures that need you to capture specific clinical values for coding, see to it that the people in your practice who code your claims have access to them or else they won't know the claims are eligible for PQRS.

Reporting wrong information. This means that you have used wrong specifications, quality data codes or individual NPI numbers.

See to it that you use correct measure specifications for the current year and reporting method. For measures that need more than one QDC (quality data code, which refers to a CPT or G code), make sure that you have reported all of the codes on the claim, and that any applicable modifiers are applied.

Make sure you include the individual rendering NPI number(s) on the claim. quality data codes should be submitted on the line item of the claim as a zero charge. If your billing software doesn't allow a zero charge line item, you can enter one cent as your charge as you can't leave the submitted charge field blank.

Missing the reporting frequency. Each and every PQRS measure has its own reporting frequency or time frame requirement for each eligible patient seen during the reporting period per eligible professional (NPI). Some measures need you to report once per patient, per NPI, each reporting period whereas others may need to be reported once per procedure carried out, once per acute episode or once per visit.

You can find the reporting frequency in the instructions section of each measure specification – however even if you know the frequency requirements, you won't be able to find them if the practitioner's documentation is not thorough. See to it that all members of the team understand and capture this information in the clinical record to facilitate reporting.

Confusing PQRS with other CMS programs. PQRS is different from the EHR program, however because the programs have similar requirements, many professionals become confused. The programs have different materials and requirements and you will need to call a separate help desk for assistance on them.

Knowing who to call for help. If you have questions about PQRS, do not just abandon the program. In its place, get in touch with the QualityNet Help Desk at 866-288-8912 or send an email to qnetsupport@sdps.org.

Remember: Various reporting errors can be avoided. Therefore report carefully since all diagnoses listed on the CMS-1500 (http://www.supercoder.com/scrubber/cms1500/) or electronic equivalent at an encounter during the reporting period will be counted in analysis.