PQRS

You’ve done your job to collect the data.

We’ll make sure your data does its job for you.

The 2015 Covisint PQRS web application is now OPEN. Click below to login or register if you don’t already have an account.

Do the 2015 PQRS reporting requirements have you totally overwhelmed and confused?

With Covisint PQRS you can confidently avoid the 2017 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?

Click on the FAQ tab to get answers to all of your PQRS questions.

Plan to attend a webinar – schedule to be posted soon. Call us at 866.823.3958 or email us at info.covisint@covisint.com.

Refer to the CMS links below for additional information

How to get Started

Registry Reporting made Simple

Value-Based Payment Modifier

  • Paper and electronic data collection methods
  • Web-based application access and data entry
  • Easy and Quick …
    The measures group option only requires 20 patients
  • HIPAA-compliant database
  • Automated data submission

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 or individual eligible professionals.

According to the final rule for 2015 PQRS reporting, to avoid the -2.0% penalty, 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 as well as one cross cutting measure.

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 2015 PQRS reporting requirements.

Measures Groups

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:

Additional Resources

Don’t see a measures group that fits? Part of a large group? Elected to report as a GPRO?

To avoid the 2017 PQRS penalty, eligible professionals (EPs) can report as individuals or elect to report as a group or GPRO. For the 2015 reporting year CMS requires EP’s report on at least 9 individual measures across 3 domains for at least 50% of Medicare Part B FFS patients for which each respective measure applies.  Less than this will subject the provider to the MAV. Additionally EPs with at least one face–to-face encounter must report at least one cross cutting measure.

Additionally in 2013 CMS introduced a Value-based Modifier (VM) component of PQRS reporting.  Both cost and quality data composites are included in calculating additional incentives 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 subject to the value modifier. Click below to learn more on reporting requirements.

By using Covisint PQRS Web portal, individual providers can self-report to meet these requirements. Select your measures, gather the denominator and numerator, enter the information through the Covisint web portal and submit. Covisint submits your data to CMS. No dropped G-codes or worries that you haven’t done enough. Register to create an account and get started.

Covisint PQRS Enterprise allows organizations to take advantage of the Registry-Based Reporting of Individual Measures as either individual eligible professionals (EP) or a group through the GPRO reporting option. GPRO reporting is also the reporting of individual measures but aggregated across the group which is based on a single TIN. Covisint analyzes data from billing and clinical data identifying eligible encounters and performance.  To report as a GPRO with Covisint, groups must first have self-nominated selecting the GPRO registry option through the CMS portal by June 30, 2015.

Looking for an on demand option to track measures and performance throughout the year?  Look no further than the Covisint Dashboard. Reports are used to drive performance with actionable information. The reports are delivered via a secure portal where they can be viewed and downloaded. All reports use drilldown capabilities where appropriate and are designed to be immediately useful for quality improvement to either data collection infrastructure or care delivery workflow. Contact us at 866.823.3958 to learn more or sign up.

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.

Understanding PQRS

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.

There are no longer any incentives for PQRS reporting. Additional penalties or incentives based on the Value Based Modifier (VM), however, may apply. Refer to the VM question for more information.

Eligible Professionals (EPs) who successfully report PQRS in 2015 can avoid a -2.0% payment reduction in your 2017 fee schedule reimbursements. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.

CMS considers all result information related to your submission confidential to your practice and Covisint does not have access to this information. Historically this information is available in the fall of the year following the reporting year. See the next question on feedback reports for more.

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, payment and penalty 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.

You can contact the Quality Net Help Desk at 866-288-8912 or visit their http://www.qualitynet.org/. Additional information can also be found on the CMS website. You can also participate in CMS-sponsored National Provider Calls.

PQRS 2015 Reporting Requirements

Some of the changes for 2015 PQRS reporting are below. This list is not intended to be all inclusive. Refer to the CMS PQRS webpage for additional information.

  • There are two new measures groups. Five measures groups were dropped. See question below on available measures groups for 2015.
  • Failure to report will result in a negative payment adjustment of -2.0% in 2017. Additional penalties or incentives based on the Value Based Modifier (VM) may also apply. Refer to that question for more information.
  • EP’s with 2+ providers must either 1) register to report as a GPRO OR 2) at least ½ of the eligible professionals under their tax ID must report successfully. See the question on the VM for more information.
  • Refer to the 2015 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 at a 50% reporting rate in order to avoid the payment adjustment. In addition EP’s who have at least one face-to-face encounter are required to report a minimum of one cross-cutting measure. 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.
  • Groups with 100+ providers are required to have all CAHPS for PQRS survey measures reported on its behalf via a CMS certified survey vendor, and report at least 6 additional measures, outside of CAHPS for PQRS, covering at least 2 of the NQS domains using the qualified registry.

New in 2011 and remaining for 2015 is the zero percent performance rule– see question specific to this topic below for additional information.

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 and Q&A sessions throughout the year which you can attend. See the main page for a schedule.

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 as well as one cross-cutting measure if they have at least one face-to-face encounter. EP’s reporting less than 9 measures will be subject to the MAV. Refer to our website for the document on the MAV process.

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.

It depends on the reporting option. The 2015 requirement for the measure group reporting option is that greater than half or 11 out of 20 patients must be Medicare Part B FFS (primary, secondary or railroad).

The individual measure reporting option through a qualified registry requires reporting on only Medicare Part B FFS patients including primary, secondary and railroad.

A measures group is composed of six 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 21 approved measures groups for 2015 reporting. The following measures groups are available:

  • Asthma (5-64)
  • CABG (18+)
  • CAD (Coronary Artery Disease) (18+)
  • Chronic Obstructive Pulmonary Disorder (COPD) (18+)
  • CKD (Chronic Kidney Disease) (18+)
  • Dementia (All ages)
  • Diabetes (18-75)
  • General Surgery (18+)
  • Heart Failure (18+)
  • Hepatitis C (18+)
  • HIV/Aids (13+)
  • Irritable Bowel Disease (IBD) (18+)
  • Oncology (18+)
  • Optimizing Patient Exposure to Ionizing Radiation (OPEIR) (18-75)
  • Parkinson’s (18+)
  • Preventive Care (50+)
  • RA (Rheumatoid Arthritis) (18+)
  • Sleep Apnea (18+)
  • Total Knee Replacement (TKR) (18-75)

New in 2015:

  • Acute Otitis Externa (AOE) (2+)
  • Sinusitis (18+)
No. Submitting more data than required will not earn additional incentive.

The zero percent rule implemented in 2011 continues for 2015 Physician Quality Reporting. Whether reporting individual measures or a measures group measures with a 0% performance rate (100% for inverse measures) are not considered successfully 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. Note: An inverse measure with a 100% performance rate will not be counted as satisfactorily reporting the measures group. 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.

The measures you choose should be based on your specialty and patient population. There are over 300 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.

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. Groups who would like to report as a GPRO in 2015 must register by June 30, 2015. Be sure you understand exactly what is required before you make the election as you can’t change your mind after the deadline has passed.

CMS began 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.

These are separate incentive programs with different reporting requirements and penalties may be applied for both.

No, the e-Prescribing incentive program is over.

No. However, documentation in the patient’s chart is required. We recommend that you retain a copy of the source you used to determine reported patients for auditing purposes. EP’s are responsible to CMS for any audit requirements.

Reporting through Covisint

  1. Measures Group (all 25 are available)
  2. Individual Measures
  3. Data Mining
    1. GPRO
    2. Individual Measures
Yes. You can submit both methods but CMS will not combine two methods in order to meet the requirements. CMS will review all submissions and accept the submission that is most beneficial to the provider.

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.

  1. 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)
  2. 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)
  3. 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)
  4. 4. 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.
  5. 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.
  6. Submit
  7. 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.
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 2015 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.

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 (≥25 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.

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.

The Covisint web application will close for 2014 PQRS reporting on March 4, 2016. Be sure that your submission is completed in time to allow for any necessary corrections or changes. Once we close for the reporting year all submissions are considered FINAL. Covisint strongly recommends you do not wait until the final weeks to report.

You can reach Covisint PQRS Sales at 866-823-3958 or info.covisint@covisint.com. For assistance with a password reset only call Covisint PQRS support at 866-823-3959.

PQRS Enterprise Services

Covisint is a PQRS registry vendor and 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.

Yes. Covisint PQRS Enterprise is recognized by CMS as a “registry” or qualified alternative reporting method. Eligible Professionals can submit registry approved measures through Covisint. To use the PQRS Enterprise service, a provider will submit claims data files (Billing, PMS, Results and Meds) at the end of the 2015 PQRS reporting year. These files must provide data on ALL MEDICARE PART B patients (primary, secondary and Railroad). Covisint analyzes the data to identify measures the provider can successfully report for the 2015 reporting year. Once measure information is identified providers or groups can choose which measures to submit – either all of them or a subset.
To avoid the -2% PQRS penalty which would be applied in 2017, eligible professionals (EPs) can report as individuals or elect to report as a group or GPRO. For the 2015 reporting year the PQRS requirement is to report on at least 9 individual measures across 3 domains for at least 50% of Medicare Part B FFS patients for which each respective measure applies. Less than this will subject the provider to the MAV. Additionally EPs with at least one face–to-face encounter must report at least one cross cutting measure.

In 2013 CMS introduced the Value-based Modifier (VM) component of PQRS reporting. Groups with 2+ EP’s must either report for at least half of the providers in the group or elect to report as a GPRO to avoid an additional -4% penalty. Both cost and quality data composites are included in calculating additional incentives 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 subject to the value modifier.

GPRO is a group provider reporting option. As a GPRO you are reporting as a group of providers which is not to be confused with measures group reporting which is a group of measures reported by an individual provider. When registering you need to choose GPRO registry as your reporting option in order to report through Covisint.
Covisint can report on behalf of a group who registered to report GPRO Registry. Covisint uses the same analysis process to identify measures for the GPRO as a whole. Groups have until June 30, 2015 to self-nominate through CMS to report as a GPRO. Be sure you understand the requirements prior to registering as you cannot change once the registration period has passed.
Note, providers who are part of a Medicare SSP ACO GPRO cannot report through a registry.
Covisint PQRS Enterprise customers can submit their final data files between January 1, 2016 and March 15, 2016. Data must be captured during office visits that occurred from January 1, 2015 through December 31, 2015.
Covisint PQRS supports all individual registry measures and can process submitted data files containing information pertinent to reporting the specialty-specific measure(s).
Yes, Covisint can accept your clinical or billing data files. No manual data entry through Covisint is required. Please contact Covisint at 866.823.3958 to discuss the data specification requirements.
Covisint guarantees that the submission will meet the CMS format required of us as a GPRO registry vendor. Guarantee of receipt of submission is dependent upon your GPRO reporting option selection being GPRO Registry. We cannot guarantee CMS incentive payment under the value-modifier. 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.
Yes, all data reported must be for Medicare Part B Fee-For Service patients. Railroad Retirement and Medicare secondary payer are included.
Yes, you can submit data files for Covisint PQRS Enterprise to process. CMS identifies and uses the method of submission that is most advantageous to the provider. However, CMS will not merge two methods of submission.
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!
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.
CMS releases information in the fall of the year following the reporting year. It will be sent to you directly and not to Covisint.
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 2014was the final year to earn an incentive just for reporting. Providers who do not successfully submit their PQRS data in 2015 will receive a payment adjustment of -2.0% in 2017.

In addition CMS will apply a value based modifier (VM) with both cost and quality data composites 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 and demonstration of performance standards through PQRS and by 2017 will be affected by the value modifier. Click here for more on the value-based payment modifier.

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 and Covisint is not required to submit the details to CMS at the time of submission.
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.