Healthcare: Physician Quality Reporting System (PQRS)
Covisint PQRS 2014 registry is now open.
Do the 2014 PQRS reporting requirements have you totally overwhelmed and confused?
With Covisint PQRS you can confidently earn the final .05% incentive payment AND avoid the 2016 payment adjustment of -2.0%. Our PQRS experts receive calls daily with questions like,
- What if I don't participate in PQRS?
- Should I register as a GPRO?
- Should I report a measures group or individual measures?
- How will the Value Based Modifier affect me?
Call us at 866.823.3958 or email us at email@example.com.
PQRS Made Easy
Participation in the Physician Quality Reporting System, formerly known as PQRI, does not have to be complicated with complex coding systems and expensive manual processes. Whether a single provider or large hospital group, Covisint PQRS simplifies the PQRS process.
PQRS for large provider groups, Hospitals, GPRO
According to the final rule for 2014 PQRS reporting, each eligible professional needs to report at least 9 individual measures across 3 domains for at least 50% of their applicable Medicare Part B FFS patients. Large provider groups can use Covisint PQRS to meet these requirements by providing a combined data file that includes data from:
- Practice Management, Billing and/or Claims Systems
- Lab Data
- Prescriptions or Pharmacy Claims Data
The data is evaluated to determine which CMS measures are applicable to your patient population, analyzed to determine the distribution of measures per provider (or per group for GPRO) and electronically submitted to CMS. Covisint PQRS offers a simple, effective and affordable way for every provider to meet the 2014 PQRS reporting requirements.
PQRS Web Application for Self Reporting
One reporting option for eligible professionals (EPs) is to report a single measures group. A measures group is a group of quality measures for a particular condition. Covisint offers all 25 CMS-approved measures groups. Simply use our data collection forms to collect the clinical data for 20 unique patients (greater than half need to be Medicare Part B fee-for-service) then enter and submit the data using the Covisint PQRS application. No coding errors—just real clinical data resulting in real payments.
Measures Group data collection forms:
Individual Measure Reporting:
Don't see a measures group that fits? To avoid the penalty, EPs can report on at least 3 individual measures for at least one domain on 50% of Medicare Part B FFS patients to which a measure applies. To earn an incentive, EPs need to report on at least 9 individual measures across 3 domains for at least 50% of the Medicare Part B FFS patients to which each measure applies. By using Covisint PQRS, providers can self-report to meet these requirements. No dropped G-codes or worries that you haven't done enough. Click below for more information.
Announcing The Covisint PQRS Dashboard
Simplifying the ongoing management of PQRS measures.
- Appropriately focus your resources where they can have the greatest impact.
- Maximize your incentives at the end of the year…earn the full incentive payments to which you're entitled AND avoid the 2016 payment adjustment of -2.0% entirely
- Depending on your Medicare census, this could be a bottom line impact of hundreds of thousands of dollars for a 100 physician facility
Q. What is the Physician Quality Reporting System?
Formerly known as PQRI (Physician Quality Reporting Initiative), the Physician Quality Reporting System (PQRS) is a CMS Pay-For-Performance program that started in 2007. It began as a voluntary, incentivized program where eligible physicians report quality clinical data collected during patient visits to CMS. Participation in Physician Quality Reporting is now mandated and failure to report will result in penalties. There are multiple ways to report data for Physician Quality Reporting including:
- Claims-based - where quality data codes associated with individual measures (pieces of clinical data) are reported and turned in on claims directly to CMS
- EHR-based – where eligible professionals report quality measures using a qualified EHR
- Registry-based – where eligible professionals or groups report data for individual measures or measures groups to a CMS-certified registry like Covisint PQRS
For additional information, visit the CMS website at www.cms.gov/pqri.
Q. What does this program have to do with improving patient and care quality?
The Physician Quality Reporting System is designed to "support the delivery of consistent high-quality care, promote efficient outcomes in our healthcare system", as well as to encourage appropriate documentation of data in a patient's medical chart for follow up or reference at a later date/time. Reporting the requested data for the Physician Quality Reporting System promotes awareness by providers and practices about what data may or may not be fully or appropriately documented during their current processes.
Q. How do I know if I am eligible to participate in the Physician Quality Reporting System?
Refer to the CMS list of eligible professionals at http://www.cms.gov/.
Q. What is the incentive for 2014 PQRS reporting?
One-half percent (.5%) of the eligible provider's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services provided during the 2014 reporting year. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.
Q. How much is the penalty and how is it applied?
Eligible Professionals (EPs) can successfully report PQRS in 2014 to earn both an incentive as well as avoid a -2.0% payment reduction in your 2016 fee schedule reimbursements. EP's can choose to report to avoid the penalty only and not earn an incentive. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.
Q. How and when will I be paid?
CMS will release incentive payments using the same method in which you receive your standard Medicare reimbursements. For example, if you typically receive reimbursements via direct deposit your incentive payment will be received via direct deposit. If you submit for multiple providers under the same practice, all incentive payments will come together as a lump sum. Historically, payments are distributed in the fall of the year following the reporting year. Payment information is confidential to your practice and Covisint does not have access to this information.
Q. What is a Feedback Report and how do I get one?
Feedback Reports are available for every TIN under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported. Feedback Reports provide a breakdown of submission data, eligibility, and payment information. These reports are not automatically provided and must be requested from CMS and your Medicare carrier.
In 2012 CMS added the ability to request a feedback report through the Quality Reporting Communication Support page at http://www.qualitynet.org/pqrs (see the Related Links in the upper left corner of the web page). Click on the Communication Support Page link then choose Create NPI Level Report Request and follow the instructions to request your feedback report.
Q. How can I contact CMS with additional questions?
PQRS 2014 Reporting Requirements
Q. Are there any changes for 2014?
Some of the changes for 2014 PQRS reporting are below. This list is not intended to be all inclusive. Refer to the CMS PQRS webpage for additional information.
- There are three new measures groups, See question below on available measures groups for 2014.
- Failure to report will result in a negative payment adjustment of -2.0% in 2016. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.
- Refer to the 2014 Measure Group specifications for each measure group to see any specific reporting and patient requirements changes.
- Individual measure reporting requires reporting on 9 measures across 3 domains in order to earn the incentive or 3 measures across one domain to avoid the payment adjustment. EPs who report 1-8 measures will be subject to the Measure-Applicability Validation (MAV) process. Refer to the CMS webpage for more information on MAV.
New in 2011 and remaining for 2014 is the zero percent performance rule– see question specific to this topic below for additional information.
Q. How do I get started and which reporting option I should choose?
Eligible professionals should consider their practice, specialty, size, resources, and technology used when determining how to report. Refer to the CMS How to Get Started web page for reporting options and additional information. Covisint also offers free webinars throughout the year which you can attend or contact a Covisint expert directly at 866.823.3958.
Q. What is the reporting criteria for Individual EPs?
Individual EPs can report through a registry using the individual measure reporting option or on a single measures group. Individual measure reporting requires 9 measures across 3 domains at a 50% reporting rate in order to earn the incentive. Only 3 measures for one domain needs to be reported to avoid the penalty.
For measures group reporting EPs can report on one measures group for 20 applicable patients.
Refer to the CMS registry reporting made simple document for more information.
Q. Do all the patients have to be traditional Medicare Part B Fee-For-Service?
It depends on the reporting option. The 2014 requirement for the measure group reporting option is that greater than half or 11 out of 20 patients must be Medicare Part B FFS.
The individual measure reporting option through a qualified registry requires reporting on only Medicare Part B FFS patients including primary, secondary and railroad.
Q. What are the available measures groups for 2014?
A measures group is composed of four to ten individual measures and they are created and approved by CMS. Measures groups are not editable to include or omit specific individual measures. Covisint will offer all 25 approved measures groups for 2014 reporting. The following measures groups are available:
- Asthma (5-64)
- CAD (Coronary Artery Disease) (18+)
- CKD (Chronic Kidney Disease) (18+)
- Diabetes (18-75)
- Hepatitis C (18+)
- Perioperative (18+)
- CABG (18+)
- Back Pain (18-79)
- Cardiovascular Prevention (18+)
- Chronic Obstructive Pulmonary Disorder (COPD) (18+)
- Dementia (All ages)
- Heart Failure (18+)
- HIV/Aids (13+)
- IVD (Ischemic Vascular Disease) (18+)
- Preventive Care (50+)
- RA (Rheumatoid Arthritis) (18+)
- Cataracts (18+)
- Oncology (18+)
- Hypertension (15-90)
- Irritable Bowel Disease (IBD) (18+)
- Parkinson's (18+)
- Sleep Apnea (18+)
New in 2014:
- General Surgery (18+)
- Optimizing Patient Exposure to Ionizing Radiation (OPEIR) (18-75)
- Total Knee Replacement (TKR) (18-75)
Q. Will I earn additional incentive submitting data on more than one measure group?
No. Submitting data for multiple measure groups will not earn additional incentive.
Q. What if none of the measures groups or measures within the measures group applies to us? (Zero Percent Performance Rate)
The zero percent rule implemented in 2011 continues for 2014 Physician Quality Reporting. An eligible professional reporting via registry for a measures group needs to report all of the measures in the group (where the patient is eligible for the measure) for 20 patients AND have a performance rate >0% for each applicable measure during a specified reporting period to be considered incentive eligible. In cases where a measure within a measures group is not applicable to a patient, the patient would not be counted in the performance denominator for that measure, so those patients should not be affected (e.g., Preventive Care Measures Group - Measure #39: Screening or Therapy for Osteoporosis for Women would not be applicable to male patients according to the patient sample criteria).
An answer of "Not Done/Unknown" or "Performance Not Met" equivalent for all eligible patients for a given measure within the measures group will result in a performance rate of 0% for that measure and the provider will not have successfully reported.
Providers with specialties that do not fit within the guidelines for measures groups approved by CMS are encouraged to report using an alternative reporting method. Covisint also offers an individual measure reporting option. Refer to our webpage for more information on alternative reporting methods or contact us for additional information.
Q. How do I choose which individual measures to report?
The measures you choose should be based on your specialty and patient population. There are over 200 individual registry measures from which to choose. Consider measures you already track for other programs however make sure the specifications are identical and that you are measuring the same thing. Other considerations and information on measure selection can be found on the CMS PQRS measure codes webpage.
Q. What is a GPRO?
In 2010 CMS added the group practice reporting option or GPRO. Groups of eligible professionals reporting under a single tax id have the option to self-nominate to report as a group instead of individually. There are several ways to participate including through a qualified GPRO registry such as Covisint. For more information on reporting as a GPRO click here.
Q. What is the Value Based Modifier?
CMS will begin applying a value based modifier (VM) in 2015 based on 2013 PQRS reporting. Both cost and quality data composites are to be included in calculating payments for physicians. All physicians who participate in Fee-For-Service Medicare will be impacted by CMS' emphasis on reporting quality data through PQRS and by 2017 will be affected by the value modifier. Click here for more on the value-based payment modifier.
Q. If I participate in the Meaningful Use/EHR incentive do I still have to participate in the Physician Quality Reporting System?
These are separate incentive programs with different requirements and incentive payments. The Physician Quality Reporting System is not included in the Meaningful Use incentive unless you have self-nominated to participate in the EHR/PQRS pilot program. For 2014, you can participate in both programs and receive both incentive payments. Furthermore, only participation in 2014 PQRS will let you avoid the -2.0% penalty in 2016. Please note that successfully participating in one program does not give you credit for the other.
Q. Do I still need to report for e-prescribing?
No, the e-Prescribing incentive program is over. Penalties are being applied in 2014 for those who failed to report successfully in 2012 or by June 30, 2013. For additional information about the e-Prescribing program, please contact CMS.
Q. Does a copy of the patient appointment list have to be submitted with the data?
No. However, in the event validation of a patient visit is required, be sure to document the completed measures in the patient chart and retain a copy of the source you used to determine reported patients for auditing purposes.
Reporting through Covisint
Q. What PQRS reporting options are available through the Covisint PQRS registry?
- Measures Group (all 25 are available)
- Individual Measures
- Data Mining
- Individual Measures
- Qualified Clinical Data Registry
Q. If I have already started reporting data with my claims can I still submit data for payment using Covisint PQRS?
Yes. You can submit both methods but you will only be paid the .5% incentive once. CMS will review all submissions and accept the submission that is most beneficial to the provider.
Q. Is Covisint an approved CMS registry?
Yes, check the 2014 Qualified Registry Vendor list on the CMS website.
Q. We self-nominated to report as a GPRO, can you help us?
Yes, Covisint is a qualified registry and can report on behalf of a group who self-nominated choosing the GPRO registry reporting option. Covisint analyzes your claims and available clinical data files to identify applicable measures and performance for your physician group. Contact sales directly at 866-823-3958 for more information or to sign up.
Q. What are the requirements to submit a measures group using the Covisint PQRS web application?
- Register each provider using their Individual NPI and Federal TIN.
(Note: Changes in TIN during the reporting calendar year may require multiple reporting, once under each TIN. Contact a Sales representative at 866-823-3958 for guidance)
- Each provider selects one measure group to report (if there are multiple providers in a practice they do not have to report the same measure group)
- Each provider selects 20 unique patients, of which greater than half or a minimum of 11 need to be Medicare Part B Fee-For-Service patients that meet ALL the requirements for the selected measure group (Refer to the Measure Group Guides on our Home Page once registered and logged into the web application for patient and reporting requirements)
- Answer all the individual measures within the selected measure group for each of the patients, making sure to leave nothing blank. For most measures, there is the option to answer "Not Done/Unknown" or something similar. However, you cannot report "Not Done/Unknown" or "Performance Not Met" for all 20 patients for any given individual measure within the measure group.
Please refer to the question that explains the zero percent performance rates.
- Once you've collected the data on all 20 patients, log into the web application using your username and password and enter the patient data under the appropriate provider.
- If you have Internet connection in the exam room, you can skip using the data collection forms to collect the data and enter it directly into the web application at the time of the visit.
- Register each provider using their Individual NPI and Federal TIN.
Q. If I registered for Covisint PQRS last year, do I need to register again this year?
No. You do not need to re-register to access the web application. Your login credentials will carry over each year. Use your same username and password to login to the 2014 web application. If you cannot remember your username and/or password please contact the Covisint PQRS Support Team at 866-823-3959 to have it reset.
Q. What is the cost to report PQRS data through Covisint?
It is $299 per provider to submit using the Covisint PQRS web application. There is no registration fee and no upfront costs. The one-time payment of $299 per provider is paid at the time of submission using any major credit card. Discounts may be available through your state medical society. Physician organizations can contact Covisint for discounted pricing.
The fee for Covisint PQRS Enterprise for large provider groups or GPROs varies slightly depending on the number of submitted providers. This service is more costly than the web application. As such, we recommend it for larger practices (≥50 providers) to ensure cost effectiveness. There is an upfront data file processing fee and a per provider submission fee. Please contact a Covisint PQRS Sales representative at 866-823-3958 for additional pricing information on this reporting option.
Q. Can we be invoiced for our providers' submissions?
Yes. You will need to contact a Covisint PQRS Sales representative at 866-823-3958 to receive a coupon code to use at each submission. No provider data will be transmitted to CMS until payment is received in full.
Q. When is the last day to report for 2014?
The Covisint web application will close for 2014 PQRS reporting on February 28, 2015. Check our website for any changes to this date. Be sure that your submission is completed in time to allow for any necessary corrections or changes.
Q. How do I contact Covisint for additional questions or support?
You can reach Covisint PQRS Sales at 866.823.3958 or firstname.lastname@example.org. For assistance with a password reset only call Covisint PQRS support at 866-823-3959.
PQRS Enterprise FAQ
Q. How can Covisint help me with PQRS?
Covisint offers the following options for providers to report PQRS:
- PQRS Enterprise – Claims or billing and clinical data files are sent to Covisint and analyzed to identify measures for reporting at the individual provider level.
- PQRS GPRO – Claims or billing and clinical data files are sent to Covisint and analyzed to identify measures for reporting at the group level.
- PQRS Dashboard – Claims or billing and clinical data files are sent to Covisint on a regular basis and analyzed to identify measures for reporting at either the group or the individual provider level.
- PQRS Web – Self-service online submission.
Contact Covisint Sales at 866.823.3958 to learn more and determine the right reporting option for your provider organization.
Q. When using an alternative reporting method for 2014 PQRS, can clinicians/physicians or healthcare facilities choose any measures to report?
Yes. Covisint PQRS Enterprise is recognized by CMS as a "registry" or qualified alternative reporting method. To use the PQRS Enterprise service, a provider will submit claims data files (Billing, PMS, Results and Meds) at the end of the 2014 PQRS reporting year. These files must provide data on ALL MEDICARE PART B patients. Covisint analyzes the data to identify measures the provider can successfully report for the 2014 reporting year. Once measure information is identified providers or groups can choose which measures to submit – either all of them or a subset.
Q. What if I register to report as a GPRO?
Covisint can report on behalf of a GPRO. Covisint uses the same analysis process to identify measures for the GPRO as a whole. However, providers who are part of a Medicare SSP ACO GPRO cannot report through a registry.
Q. What is the last day I can submit my data to Covisint?
Covisint PQRS Enterprise customers can submit their final data files between January 1, 2015 and February 15, 2015. Data must be captured during office visits that occurred from January 1, 2014 through December 31, 2014.
Q. My physician is a specialist. Can s/he report on specialty-specific measures?
Covisint PQRS supports all individual registry measures and can process submitted data files containing information pertinent to reporting the specialty-specific measure(s).
Q. We do not want to manually enter data. Can Covisint accept claims and/or clinical data from a database we maintain?
Yes, Covisint can accept your clinical or billing data files. No data entry is required. Please contact Covisint at 866.823.3958 to discuss the data specification requirements.
Q. Will my submission be accepted by CMS?
Covisint guarantees that the submission will meet the CMS format. We cannot guarantee CMS incentive payment. Once your PQRS information is submitted to Covisint, we review the data for context and parameters (e.g. field length) prior to calculating numerators and denominators. The numerators and denominators are then submitted to CMS with the provider demographic information. This particular Covisint PQRS solution incorporates significant advanced data validation and screening to offer the highest opportunity for CMS acceptance of the submitted data, creating low risk for participation and high expectations for payment.
Q. Do all the patients have to be traditional Medicare Part B Fee-For-Service patients?
Yes, all data reported must be for Medicare Part B Fee-For Service patients. Railroad Retirement and Medicare secondary payer are included.
Q. If I have already started reporting PQRS data with my claims, using G-codes and the 50% rule, can I submit data for payment using Covisint PQRS?
Yes, you can submit data files for Covisint PQRS Enterprise to process. You WILL NOT receive more than .5% of your annual reimbursement by using BOTH claims reporting and an alternative reporting method such as the Covisint PQRS Enterprise pathway. CMS identifies and uses the method of submission that is most advantageous to the provider. However, CMS will not merge two methods of submission.
Q. Will I make more money using Covisint PQRS data with my claims, using G-codes and the 50% rule; can I submit data for payment using Covisint PQRS?
Covisint PQRS Enterprise or GPRO service is a retrospective analysis. As such, there is the potential to find more measures met than required and more patient data that may have been missed or overlooked in the claims reporting for the selected measures. Our "deeper dive" into the data can mean the difference between unsuccessfully reporting versus successfully reporting to earn the .5% incentive or more importantly avoid the 2.0% penalty!
Q. How will I know when I have completed my PQRS reporting requirement?
Covisint provides a report of the processed data, clearly indicating the performance and reporting percentages. Denominator applicable measures are identified for individual providers or a GPRO. Further, the report provides performance information for each measure and a quality performance rate. Once you have attested to the information provided to you by Covisint, it is submitted to CMS and your submission is complete.
Q. How will I be paid?
CMS disburses the PQRS incentive using your standard Medicare reimbursement processes. If you have multiple providers submitting from the same practice, all incentive payments will be distributed at one time as a lump sum payment.
CMS establishes the timeframe in which payments are made to submitting providers. Based on previous years' experience, payment should be received in Fall 2015.
Q. What does PQRS have to do with improving patient quality?
According to CMS, PQRS "gives eligible providers 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. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers." The PQRS program began with incentives to encourage providers to participate; however 2014 is the final year to earn an incentive just for reporting. Those who participate successfully in 2014 will also earn a .5% incentive for their efforts. Providers who do not successfully submit their PQRS data in 2014 will receive a payment adjustment of -2.0% in 2016.
In addition CMS will begin applying a value based modifier (VM) in 2015 based on 2013 PQRS reporting. Both cost and quality data composites are to be included in calculating additional payments or penalties for physicians. All physicians who participate in Fee-For-Service Medicare will be impacted by CMS' emphasis on reporting quality data through PQRS and by 2017 will be affected by the value modifier. Click here for more on the value-based payment modifier.
Q. Does a copy of the patient appointment list or other patient files have to be submitted to CMS with the data?
No, as long as the original data file provided to Covisint PQRS is available for reference should CMS have questions. It is always suggested that you maintain copies of the data you provide. However, maintaining additional hard-copy or other copies is not necessary.
Q. How is the 2014 PQRS .5% incentive payment calculated?
CMS will review and analyze the submitted data to determine satisfactory reporting and eligibility for incentive payment. The payment is .5% of a provider's total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the 2014 reporting period.
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