Using PQRS? Five Common Pitfalls You Should Watch Out For

Whether you are new to CMS's Physician Quality Reporting System (PQRS) program or have been getting bonuses from it for a while, you can use some tips on ways to avoid common PQRS errors. On a March 22 call, CMS representatives shed light on these issues and shared the following information about the five most common PQRS pitfalls.


Missing your eligible population:


When you are choosing 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 even before you can report them such as age or gender parameters.


For those measures that call for you to capture clinical values for coding, ensure 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 you have used wrong specifications, quality data codes, or individual NPI numbers. See to it that you use correct measure specifications for the present year and reporting method. For measures that need more than one quality data code (QDC, which refers to a CPT or G code), ensure that you have reported all of the codes on the claim and that any applicable modifiers are added.


See to it that you include the individual rendering NPI number(s) on the claim. These quality data codes should be submitted on the line item of the claim as a zero charge. If your billing software does not permit a zero charge line item you can enter one cent as your charge since you can't leave the submitted charge field blank.


Missing the reporting frequency: Each 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 require you to report once per patient, per NPI, each reporting period (also called 'patient-level') while others may need to be reported once per procedure performed, once per acute episode or once per visit.


You can find the reporting frequency (also referred to as 'measure tag') in the instructions section of each measure specification – however even if you know the frequency requirements, you will not be able to find them if the practitioner's documentation is not thorough. See to it that all members of the team know 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 the programs have similar requirements, many eligible professionals puzzle them. The programs have different materials and requirements, and you will need to call a separate help desk for aid on them.


Being aware of whom to call for help


If you have got 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.


For further details on ICD-9-CM diagnoses and for more tips to make a smooth transition, sign up for a medical coding guide like Supercoder.