The Covisint PQRS 2016 application will close on March 10, 2017 at 8:00 PM ET.

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Covisint will support CMS MIPS Quality Payment Program in 2017 and beyond. Continue to count on Covisint for your reporting under the MIPS program. We plan to open our portal for data entry in Spring 2017. Stay tuned for future webinars and additional information as we have it.

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Do the 2016 PQRS reporting requirements have you totally overwhelmed and confused?

With Covisint PQRS you can confidently avoid the 2018 payment adjustment of -4.0% to -6.0% depending on the size of the organization. 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.

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 2016 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 24 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 2018 PQRS penalty, eligible professionals (EPs) can report as individuals or elect to report as a group or GPRO. For the 2016 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, 2016.

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.

Understanding PQRS

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
  • Web Interface – where groups report directly through the CMS portal

For additional information, visit the CMS website.

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 2016 can avoid a -2.0% payment reduction in your 2018 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 (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 Additional information can also be found on the CMS website. You can also participate in CMS-sponsored National Provider Calls.

PQRS 2016 Reporting Requirements

Some of the changes for 2016 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 – Cardiovascular Prevention, Diabetic Retinopathy, and Multiple Chronic Conditions. See question below for all available measures groups offered by Covisint in 2016.
  • Failure to report will result in a negative payment adjustment of -2.0% in 2018. 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 2016 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 MAV document for more information on the MAV process.
  • 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 2016 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 individual 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 2016 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. They are only reportable by individual eligible professionals. Measures groups are not editable to include or omit specific individual measures. Covisint will offer 24 approved measures groups for 2016 reporting. The following measures groups are available:

Acute Otitis Externa (AOE) (2+) Hepatitis C (18+)
Asthma (5+) HIV/Aids (13+)
CABG (18+) Irritable Bowel Disease (IBD) (18+)
CAD (Coronary Artery Disease) (18+) Multiple Chronic Conditions (66+)
Cardiovascular Prevention (21+) Oncology (18+)
Chronic Obstructive Pulmonary Disorder (COPD) (18+) Optimizing Patient Exposure to Ionizing Radiation (OPEIR) (18-75)
CKD (Chronic Kidney Disease) (18+) Parkinson’s (18+)
Dementia (All ages) Preventive Care (50+)
Diabetes (18-75) RA (Rheumatoid Arthritis) (18+)
Diabetic Retinopathy (18-75) Sinusitis (18+)
General Surgery (18+) Sleep Apnea (18+)
Heart Failure (18+) Total Knee Replacement (TKR) (18-75)
No. Submitting more data than required will not earn additional incentive.
The zero percent rule implemented in 2011 continues for 2016 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. 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.

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 (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). If there are NO eligible patients for a given measure within a measures group the result would be a 0/0 or NULL performance and would be considered acceptable reporting.

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 nearly 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. Groups who would like to report as a GPRO in 2016 must register by June 30, 2016. Be sure you understand exactly what is required, including cost and ability to provide required data, 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 2016 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 2016 value-based payment modifier.
Yes, these are separate incentive/penalty programs with different reporting requirements and penalties may be applied for both.
No, the e-Prescribing incentive program is over.
No, the MU CQM measures must come from your EMR/EHR.
No. However, documentation in the patient’s chart is required. We recommend that you retain a copy of the source documents 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 (there are 24 available)
  2. Individual Measures (reported by individual EPs through the Covisint web portal)
  3. Data Mining Analysis
    1. GPRO
    2. Individual EPs
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 before the June 30, 2016 deadline 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. A GPRO cannot report through our web tool. 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. 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. Review your PQRS Submission Summary report to verify there are no 0% performance rate issues.
  7. Submit
  8. 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 Covisint web application. Your login credentials will carry over each year. Use your same username and password to login to the 2016 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.
The Covisint web application will close for 2016 PQRS reporting on March 3, 2017. Check our website for any changes to this date which is subject to change as required. 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 For assistance with a password reset only call Covisint PQRS support at 866-823-3959.