What You Need to Participate in PQRS in 2013


Register now for the PQRS webinar on Wednesday, October 30th at 12 pm ET (9 am Pacific).

If you see Medicare Part B patients, you need to be aware of your options for PQRS. Your actions will determine your potential bonus incentives payments or your future payment adjustments (penalties) to your Medicare reimbursements.What you need to participate in PQRS in 2013

If you missed the PQRS administrative claims based registration deadline last week, you still have other options for participating in the program in 2013. The claims-based reporting method for avoiding the 2013 PQRS penalty involves reporting quality date codes on Medicare Part B claims for either:

  • One individual measure for at least one eligible Medicare beneficiary, or
  • One measures group for at least one eligible Medicare beneficiary.

Want to learn more?

The Physician Quality Reporting System (PQRS) is a CMS reporting program that includes incentives and penalties to promote reporting of quality information. All professional services covered by the Medicare Physician Fee Schedule (PFS) are affected by PQRS. You can access additional PQRS resources here.

The PQRS program can be very complex, and there are more changes coming in 2014. To learn more participating in PQRS in 2013 using the claims based reporting mechanism, register to attend the upcoming Practice Fusion PQRS webinar on Wednesday, October 30th at 12 pm ET (9 am Pacific).

View our presentation entitled Practice Fusion Webinar: PQRS in 2013 and Beyond

Contributing Writer

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  • Marco Vanzetti

    I am already reporting with G-codes on my billing for PQRS. Do I still need to register?

  • RickSLC

    My understanding is that, as a solo MD, I can simply report my PQRS measures codes on my claims without the need to register in the IACS system. Any misunderstanding here?

  • Melinda

    I also was told that G-codes would suffice. Am I incorrect in this assumption?

  • Sue

    It would be nice if PF automatically enabled the g codes by the dx and data we enter. When is that going to happen?

  • Emily R_PF Staff

    Hi Marco – Registration is only needed for providers wanting to report via the administrative claims based reporting option. If you are reporting via G-codes on claims, you do not need to register.

  • Emily R_PF Staff

    Hi there – you are correct. If you are reporting PQRS via G codes on claims, then you do not need to register for the administrative claims based reporting option and can continue reporting G-codes as you are.

  • Emily R_PF Staff

    Reporting G-codes is one option for meeting PQRS requirements. Another option is the administrative claims based reporting option. If you are reporting G-codes via claims, you can continue that method and do not need to register.

  • Emily R_PF Staff

    Hi Sue. Practice Fusion is looking into supporting additional PQRS functionality in 2014, including electronic PQRS submission. We appreciate your feedback on the need for automatically enabled g-codes and will consider that in our efforts for the future.

  • pj

    what is that code that you have to attach to any claim in order to let mcr know you are going to report. I can find it anywhere

  • R Kurt Meier III

    I thought that if we were submitting and qualifying for meaningful use that PQRS was already taken care of. Is that just for Rx? I’m now confused. HELP!

  • Emily R_PF Staff
  • Emily R_PF Staff

    Hello. The 2013 PQRS requirements for avoiding the payment penalty are not fulfilled inherently by participating in the Meaningful Use program. For more information on the PQRS program, please refer to this Practice Fusion blog post: http://www.practicefusion.com/blog/pqrs-overview-for-practice-fusion-providers/

  • Joseph M Cortez, DPM

    It claims to be voluntary, but you are penalized if you do not participate. What happens to the information we submit? I heard it was being collected by insurance companies as a means to raise your premiums.

  • Dr. D

    There is another option i understand where you pay a registry a fee and then report on individual measures. You have until Dec 31, 2013 to register and then January 31, 2014 to finish submitting data correct?

  • Marie

    Where does in PF does the provider select the individual measures they want to report on via claims

  • Emily R_PF Staff

    PQRS data is submitted to the Centers for Medicare and Medicaid and is not shared with private insurance companies. Participation is voluntary, and requirements for participation solely to avoid the payment penalty are less than the requirements for achieving the payment incentive.

  • Emily R_PF Staff

    If you want to submit PQRS measures via a data registry, you may have additional time to sign up with that particular registry. However, each registry is different. For more information on the PQRS registry reporting option, please go to: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html

  • Emily R_PF Staff

    Reporting measures via claims involves submitting quality data codes on claims that are submitted to CMS. There is no selection needed in the EHR. For information on submitted quality data codes to CMS, please go to: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html

  • Hadi

    Hi, I submit the G codes with eRx do I still need to register with PQRS
    Thanks

  • carlbeth

    my partner and I have not been reporting G codes. we just signed up with a registry today. We both chose a measurement group where all we had to do was enter some basic data for twenty patients. It was realatively painless. The fee was $200, which seems rediculous given that we entered all the data ourseves, but at this point I’ve given up complaining.

  • Deborah Beutler

    What if we start reporting with G codes on claims now?

  • mikebyrnes

    I am using G Code to report e prescribing. Are there any other G codes as podiatrists we need to report to be in compliance with PQRS and meaningful use

  • Emily R_PF Staff

    Hello. If you submitted G Codes with eRx as part of the eRx incentive program, that will not meet the requirements for the PQRS program. You will need to use one of the methods for avoiding the PQRS penalty, one of which is registering with CMS before October 15th. For more information, please register for Monday’s PQRS webinar!

  • Emily R_PF Staff

    You may be able to meet the payment incentive requirements, or the requirements for avoiding the penalty only are available (which are much easier).

  • Emily R_PF Staff

    Reporting G-codes for the eRx incentive program will not meet your PQRS requirements. PQRS uses different G codes and the measure reporting requirements are slightly different. For more information, please attend Monday’s PQRS webinar.

  • Deborah Beutler

    This seems way too complicated – where do we find these G codes? Whenever I click on something to try to figure it out, I get a 20 page document which goes in circles…
    this is very frustrating!

  • SARAH

    I PROVIDED 13 G CODES BACK IN JUNE OF THIS YEAR. DOES THIS PLAY A ROLE OR ACCOUNT FOR PQRS?

  • Emily R_PF Staff

    If the G codes you submitted earlier this year were for the CMS eRx incentive program, then they will not work for PQRS.

  • Emily R_PF Staff

    Hi there, if you are having trouble navigating the CMS documents, I recommend reaching out to the CMS QualityNet help desk.

  • Kim,L

    Kim,L
    I have not been reporting G codes this year.
    I understand I have to register for administrative claim in order to avoid penalty.
    But If I register with a registry then do I still qualify for the incentive and avoid the penalty? If I register with a registry, do I still need to get IACS number before 10/15?
    Does it matter which registry I choose? They make it sound like they have to extract data from your EHR. But from what I can figure from this blog, you have to enter the data on your own. I need advise regarding which registry to sign up for if I am elgible still.
    If I decide to do administrative claim for 2013, does that mean I cannot participate
    PQRS in 2014? Sorry to be asking too many questions at once, but I think
    everyone has same questions. HELP!!

  • Emily R_PF Staff

    Hi Kim, I recommend attending Practice Fusion’s PQRS webinar on Monday, October 14th at 12pm ET/9am PT to get answers to your questions. Due note that Practice Fusion does not support PQRS registry reporting, therefore cannot comment on the best options for using the registry-based reporting mechanism. You can find out more information on PQRS registries here: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html

    Participation in any particular method for PQRS in 2013 does not effect participation in 2014.

  • Kim,L

    Since I have not been reporting G codes in my claims this year,
    is my only option administrative claims, or can I still at this point
    register with a registry before 10/15? So, my question is, is registry
    a option for me at this point or not since I have been using EHR
    and have data? OR is my only option administrative claim?
    Please clarify, thank you.

  • Emily R_PF Staff

    All of the reporting options are technically still available. The registration for admin-claims closes on October 15th, but the reporting period ends December 31st. Therefore, you can start reporting g-codes now and choose to report the threshold for the payment incentive or to avoid the penalty, report via a registry, or register for admin-claims.

  • Vicki D

    So it is my understanding that as a solo practice we do not need to register for an IACS number or register with CMS for PQRS reporting is we choose to report by submitting G-codes/QDC on claims? Am I correct?

  • Emily R_PF Staff

    That is correct.

  • Dr. Tina

    Hi there.
    I am a solo provider as a podiatrist.
    I have not registered with any registry or have not reported any G codes.
    Today is the 14th.
    Please advise , thanx.

  • Emily R_PF Staff

    Hello. Please reach out to pqrs@practicefusion.com for assistance.

  • Lucy

    I signed up with a registry on Oct 18th, I choose a measurement group, my question is: Do I have to report g-codes in my claims??

  • ks@conroy

    Do I need to report PQRS to all insurances or just Medicare?