On December 13,CMS released the Physician Quality Reporting System (PQRS) measure documents for 2014. You are advised that some of these measures may be different from the PQRS measure documents of prior years.
2014 Physician Quality Reporting System (PQRS) Implementation Guide.
2014 Quality-Initiatives PQRS Measure Codes
Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year. The 2014 PQRS claim information is an example of how an individual National Provider Identifier (NPI) reporting on a single CMS-1500 claim for 2014 PQRS should look. A sample 1500 claim form can be found in the Implementation Guide (link above).
CMS advises that at a minimum, providers should consider the following factors when selecting measures for reporting:
• Clinical conditions usually treated
• Types of care typically provided – e.g., preventive, chronic, acute
• Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite
• Quality improvement goals for 2014
• Other quality reporting programs in use or being considered
The following documents pertaining to the 2014 PQRS individual measures are included in the 2014 PQRS Individual Claims Registry Measure Specification Supporting Documents:
• 2014 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures – Includes codes and reporting instructions for the 2014 PQRS measures for claims and/or registry-based reporting.
• 2014 Physician Quality Reporting System (PQRS) Measure Specification Release Notes – Outlines 2014 updates made to the 2013 PQRS Measures Specifications Manual in the form of release notes.
• 2014 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines, for each claims and registry measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This document identifies how each code will be used whenCMS calculates performance rates. The QDC categories table also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2014 PQRS measure specifications) will result as invalid reporting.
• 2014 Physician Quality Reporting System (PQRS) Single Source Code Master – Includes a numerical listing of all codes (denominator and numerator) included in 2014 PQRS Individual Claims and Registry Measures for incorporation into billing software.
The following documents pertaining to the 2014 PQRS group measures are available by going to: 2014 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2014 PQRS Measures Groups, 2014 Quality-Data Code Categories, and 2014 PQRS Measures Groups Single Source Code Master:
• 2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual – Measures group specifications are different from those of the individual measures that form the group. Therefore, the specifications and instructions for measures group reporting are provided in a separate manual. The 2013 measures groups specifications include codes and reporting instructions for the 22 PQRS measures groups for claims or registry-based reporting.
• 2014 Physician Quality Reporting System (PQRS) Measures Groups Release Notes – Outlines 2013 updates made to the 2012 PQRS Measures Groups Specifications Manual in the form of release notes.
• 2014 Physician Quality Reporting System (PQRS) Getting Started with Measures Groups – Provides guidance about how to select measures groups for reporting, and how to read and understand a measure group specification in order to satisfactorily report.
• 2014 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines every QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This identifies how each code will be used when calculating performance rates. This also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2013 PQRS) will result as invalid reporting. NOTE: Measures groups specifications may differ from their individual measures counterpart. This document will define the differences between the QDCs for individual and measure group specifications.
• 2014 Physician Quality Reporting System (PQRS) Measures Groups Single Source Code Master – Includes a numerical listing of all codes included in 2013 PQRS Measures Groups for incorporation into billing software.
Again, thanks to Bill Finerfrock, Zhaneta Mansaku, Kirk Shields at HBMA for writing this article.
