How To Get Started

Step-by-Step Instruction in Getting Started with the Physician Quality Reporting System

STEP 1:

Determine if you are eligible to participate. A list of professionals who are eligible and able to participate in Physician Quality Reporting System is available in the "Downloads" section of this page by clicking on the link titled List of Eligible Professionals. Read this list carefully, as not all entities are considered eligible because they are reimbursed by Medicare under other fee schedule methods than the PFS.

STEP 2:

Determine which Physician Quality Reporting System reporting option(s) best fits your practice (claims-based or registry-based reporting of either individual measures or measures groups) as well as the Physician Quality Reporting System reporting period (12 months or 6 months where applicable), which varies with the reporting option selected. Refer to the 2012 Physician Quality Reporting Participation Decision Tree in Appendix C of the 2012 Physician Quality Reporting System Implementation Guide, which is available in the "Downloads" section of this page.

STEP 3:

Review the 2012 Physician Quality Reporting System Measures List, available in the "Downloads" section of this page, and determine which Physician Quality Reporting System measures apply.

Eligible professionals who choose to report 2012 Physician Quality Reporting System individual measures should select at least three applicable measures to submit to attempt to qualify for a Physician Quality Reporting System incentive payment. If fewer than three measures are reported, CMS will apply a measure-applicability validation (MAV) process when determining incentive eligibility.

Eligible professionals who choose to report 2012 Physician Quality Reporting System measures groups should select at least one measures group to submit to attempt to qualify for a Physician Quality Reporting System incentive payment. Refer to the 2012 Physician Quality Reporting Measures Groups Specifications Manual and Release Notes to review measures group(s) applicable to your practice. The document is available in the "Downloads" section.

If you have already been participating in the Physician Quality Reporting System, there is no requirement to select new/different measures for the 2012 Physician Quality Reporting System. Please note that all Physician Quality Reporting System measure specifications are updated and posted prior to the beginning of each program year; therefore, eligible professionals will need to review them for any revisions.

STEP 4:

Individual Physician Quality Reporting Measures

Once you have selected the measures (at least three), carefully review the following documents:

1. 2012 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry for instructions on how to report claims-based or registry-based individual measures. Just print the pages for the measure specifications you are reporting as the document is very lengthy. The document is available in the "Downloads" section of this page.

2. 2012 Physician Quality Reporting System Implementation Guide which describes important reporting principles underlying claims-based reporting of measures and includes a sample claim in Form CMS-1500 format. The guide is available in the "Downloads" section of this page.

As you read the specifications and reporting instructions, you will notice that each of the measures has a QDC (a Current Procedural Terminology [CPT] II code or G-code) associated with it. Note that several measures allow the use of CPT II modifiers: 1P, 2P, 3P, and the 8P reporting modifier. Only allowable CPT II modifiers may be used with a CPT II code. Eligible professionals should use the 8P reporting modifier judiciously for applicable measures they have selected to report. The 8P modifier may not be used indiscriminately in an attempt to meet satisfactory reporting criteria without regard toward meeting the practice's quality improvement goals.

To qualify for the incentive, the correct numerator QDC must be reported on at least 80 percent of eligible instances if reporting via a registry or 50 percent of the eligible instances if reporting via claims for each selected measure. A claim is considered "eligible" in Physician Quality Reporting when the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and the CPT Category I service codes on the claim match the diagnosis and encounter codes listed in the denominator criteria of the measure specification. Refer to the “2012 Physician Quality Reporting Quality-Data Code Categories” for a complete list of how each code will be used to calculate performance rates. This document is available in the “Downloads” section.

You will also notice that each measure has a reporting frequency or timeframe requirement (called a "measure tag" in Physician Quality Reporting analysis) for each eligible patient seen during the reporting period by each individual eligible professional (NPI). The reporting frequency (i.e., report each visit, once during the reporting period, each episode, etc.) is found in the Instructions section of each measure specification. Ensure that all members of the team understand and capture this information in the clinical record to facilitate reporting.

Or: As an alternative to reporting three individual measures, you can select to report one or more measures groups.

Physician Quality Reporting System Measures Groups

Once you have selected a measures group(s) to report, carefully review the following documents:

1. 2012 Physician Quality Reporting Measures Groups Specifications Manual and Release Notes, available in the "Downloads" section of this page, for claims-based or registry-based reporting of measures groups. Just print the pages for the measure specifications, including denominator coding, you are reporting. Note that the specifications for a measures group are different from those for individual measures because they identify a common denominator across the measures group. Be sure you use the correct specifications.

2. Getting Started with 2012 Physician Quality Reporting of Measures Groups is the implementation guide for reporting measures groups. It is available in the "Downloads" section of this page.

Need Assistance? 

Contact the QualityNet Help Desk for help with:

• General CMS Physician Quality Reporting System & eRx information
• Physician Quality Reporting System Portal password issues
• Physician Quality Reporting System/eRx feedback report availability and access
• Physician Quality Reporting System-IACS registration questions
• Physician Quality Reporting System-IACS login issues

Monday – Friday; 7:00 AM–7:00 PM CST

Phone: 1-866-288-8912

TTY: 1-877-715-6222

Email: qnetsupport@sdps.org

FAQ

Visit our Frequently Asked Questions by scrolling to the "Related Links" section of this page and click on the Physician Quality Reporting System FAQ link. There you will be able to enter keywords in the search box to find answers on “How do I get started” or any other area of the program you may have questions about.

To view all of the 2012 Physician Quality Reporting System Program Requirements, click on the link titled "2012 Medicare PFS Final Rule - CMS-1524-FC" in the "Related Links" section on the “Statute Regulations Program Instructions” page at left.and go to page 73314.