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PQRS FAQ

PQRS

What is an inverted measure?

Inverted Measures:

  • Measures included: 1, 123, 146, 164, 165, 166, 167, 168, 192, 322, 323, 324, 328, 329, 330, 331, 333, 334, 345, 346, 347, 348, 388, 392, 393
  • Desired Performance Rate: 0.00%
  • Performance Rates that will count toward reporting: 0.00% – 99.99%
  • Null Performance Rate = 0/0, will count toward reporting
  • 100% Performance Rate: A rate of 100.00% disqualifies the measure and it will not count towards reporting

Non-inverted Measures:

  • Desired Performance Rate: 100.00%
  • Performance Rates that will count toward reporting: 0.01% – 100%
  • Null Performance Rate = 0/0, will count toward reporting
  • 0% Performance Rate: A rate of 0.00% disqualifies the measure and it will not count towards reporting

Group Reporting vs. Individual Reporting

We help you decide which works better and/or which is required for your practice.

How do I submit for PQRS?

We do it for you.

How do I determine reporting results?

In the fall of the year following the reporting year, CMS will post feedback reports on their website, which tell the practice how they performed on their PQRS reporting.  You must have an EIDM account to see the feedback report for a given provider or practice.  You can access feedback reports at the following website:

https://www.qualitynet.org/

How do I read the CMS Individual Specification Manual?

Use the following outline to determine how to read the specifications.

Denominator Data

Eligible Instances: The number of instances (patients, visits, episodes, etc.) that meet all eligibility criteria for a specific measure of interest, as explained in the 2015 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures (2015 PQRS Measure Spec Manual).

Example of a measure denominator description, from the 2015 PQRS Measure Spec Manual:

  • Measure #12 (NQF 0086): Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Numerator Data

The numerator must detail the clinical quality action expected that satisfies the condition(s) and is the focus of the measurement for each patient, procedure or event established by the denominator. The numerator options are “MET” and “NOT MET” for all measures with some measures having the additional option of “EXCLUDED”. Under “Numerator” in the 2015 PQRS Measure Spec Manual, the options will be separated by “OR”. The order will be MET, NOT MET if there is no EXCLUDED option. The order will be MET, EXCLUDED, NOT MET if there is an EXCLUDED option.

Performance Met: The number of eligible instances that meet the “MET” criteria. The “MET” criteria is listed first under “Numerator” in the 2015 PQRS Measure Spec Manual.

Performance Exclusion: The number of eligible instances that meet the “EXCLUDED” criteria. The “EXCLUDED” criteria is listed between the “MET” and “NOT MET” criteria under “Numerator” in the 2015 PQRS Measure Spec Manual. *This does not apply to every measure.

Performance Not Met: The number of eligible instances that meet the “NOT MET” criteria. The “NOT MET” criteria is listed last under “Numerator” in the 2015 PQRS Measure Spec Manual.

What is a TIN?

TIN stands for Tax Identification Number.

Can GPROs report on Measures Groups?

No, GPROs can only report on individual measures for PQRS.

What is the difference between GPRO and Measures Groups?

GPRO stands for Group Practice Reporting Option and is a method for a practice/TIN to submit Individual Measures to CMS for PQRS reporting. As a GPRO, a TIN can report and submit Individual PQRS Measures that are aggregated at the TIN level. GPROs can only report on Individual Measures for PQRS and must follow the same requirements.

Measures Group reporting is a different method for PQRS reporting. There are 22 Measures Groups that are measures grouped by specialty or diagnosis. If a provider reports on a Measures Group, he/she must report on 1 Measures Group for at least 20 patients (at least 11 of which must be Medicare Part B patients) that are eligible for the Measures Group. Then, the provider must answer the quality action for each patient for each measure that is included within the Measures Group. Each Measures Group has at least 6 measures, and each measure must have a satisfactory performance rate in order to avoid the PQRS penalty. Providers that are part of a GPRO cannot report on Measures Groups.

What does MAV stand for?

Measures Applicability Validation; this is a process that CMS undertakes when a provider/practice has not met the minimum reporting criteria for a specific reporting year.

What if I can’t report the minimum number of measures?

The Measures Applicability Validation (MAV) process will be invoked by CMS to review the data that has been submitted and will determine whether or not the practice/provider has submitted satisfactorily for the reporting year.