Physician Quality Reporting System (PQRS) is a pay-for-reporting program initiated by CMS in 2006. PQRS uses a combination of incentives and payment adjustments for eligible professionals, if they report quality measures satisfactorily. Eligible professionals (EPs) are identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN). EPs need to report data on quality measures for covered Physician Fee Schedule (PFS) services to Medicare Part B, Railroad Retirement Board and Medicare Secondary Payer. PQRS gives participating EPs the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Four Easy Steps To Become Eligible For PQRS Individual EPs do not need to sign-up or pre-register in order to participate in PQRS. However, to qualify for a PQRS incentive payment an EP must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period.
STEP 1: Submit claim(s) with PQRS codes for reimbursement. EPs must include a $0.01 line-item charge for the quality-data code (QDC). This is a new requirement for quality reporting via claims to CMS.
STEP 3: Do a double check to review your claims for accuracy prior to submission for reimbursement and reporting purposes.
STEP 4: Review your Remittance Advice (RA)/Explanation of Benefits (EOB) for denial code N572 after April 1, 2014. This code indicates the PQRS codes are valid for the 2014 PQRS reporting year and have been included in the QDC analysis.