Healthcare Training: Requirements For Reporting the PQRS Measures


PQRS is overwhelming especially for a busy practice. And we have to figure out how to deal with it and how to make it simpler and how to make it part of our day-to-day practice and process. Go through this expert guidance provided by our speaker in a healthcare conference and know more.

The measure is reported a minimum of once per reporting period for patients with heart failure seen during the reporting period regardless of the reason for the assessment of left ventricular function was performed.

The left ventricular systolic dysfunction may be determined by current/historical, quantitative or qualitative assessment. A healthcare training example of quantitative or qualitative assessment is an electrocardiogram documentation of numerical value of left ventricular systolic function of the descriptive terms such as moderately or severely depressed of left ventricular systolic dysfunction.

And when a left ventricular function assessment including electrocardiography, nuclear test or ventriculography and quantitative or qualitative assessment results are documented in the medical record, you can report 3020F.

When quantitative or qualitative results of left ventricular function assessment are not performed, assessment and performance reason are not specified in the medical record documentation, it would be reported as 3020F with the modifier of -8P.

So basically, with this patient, they have this problem of heart failure. You did not do left ventricular function assessment and you do not have a reason why so you report 3020F with your claim with an -8p which means the reason was not specified.

The measure rationale statement is why CMS thinks it's important to measure this type of care. And the clinical recommendation or evidence forming the basis of the supporting measure is the recommendation statements from a clinical organization supporting CMS' rationale of a quality measure. This is all in the documents of all the quality PQRS measures.

So these quality measures are numbered consecutively. Measures related to the same conditions can be scattered throughout the document. Their gaps in measuring numbers that reflect those physician quality reporting measures have been deleted in previous years and quality measure specification can be revised each year. So you have to review them carefully.

So there's a measure coding decision algorithm. Is their documentation of tobacco use screening and cessation counseling if the patient is identified as a tobacco user?

If yes, you use CPT code 24004F. If no, to either tobacco screening or cessation counseling above, select one of the CPT codes. You either code CPT code 1036F current tobacco non-user – they're not a user of tobacco – or 4004F with a -1P which means you're documenting that they're a tobacco user but you didn't screen them or 4004 with a -1P that their tobacco screening was not performed but the reason is not specified.

Claim-based reporting allows a provider to submit quality data on the paper or electronic claim. The numerators are reported using those quality data claims in item 24-D just like a CPT code and you report either a zero dollar in 24-F or if your practice management requires a dollar amount, you would report it with one cent.


And the information is combined with the demographic information, the place of service information and the diagnosis that determine the eligibility as well as the CPT that you're reporting it with. It determines whether you've met the denominator requirement for that numerator.

If you can find a measures group that applies to you, that applies to your specialty, it is well worth spending the registry fee of like, for example, PQRS Wizard. You can find them at They do checks and balances and every one of their customers get paid.

One of the problems with claim-based reporting is you don't know if you've made a mistake. You need to report 50% of your medical coding claims have to be successful at three measures. And if you make a mistake here or there or everywhere, you may not meet the requirements and you're not going to find out until it's too late and you're not going to get your bonus and you're not going to be successful.

And after 2015, not only are you not going to be successful but you're going to be dinged and be penalized. When you have a good registry that makes sure all your denominator information is correct, all your numerator information is correct. You are going to be successful. And it's easy as pie – easy as eating pie; not cooking pie. It is so simple.

The hard part is, you have to have a measures group that applies to you. And there are limited measures groups that are available and there aren't necessarily measures groups that apply to every specialty. So when selecting a registry, it's important to consider that the registries can charge as much as $300 to $1000 per doctor.

You have to consider the type of data that's collected. Ensure that the registry is collecting the type of data for the measures group that you're looking for. You have to make sure that the registry is qualified for CMS.

And if the registry is reported successfully in previous years, it's probable that they're going to be accepted as a qualified registry for this year. When the provider elects to report data via a registry, there are five reporting threshold options they're going to select.

They can select to do the individual physician quality reporting measures. And instead of the 50%, you need to do 80%. So in one way they're sort of penalizing you because you have to have a higher level of successful reporting.

So when you're working with the 80% requirement for the 12 months, it's going to make sure that before they even submit it, it's accurate and it's going to get accepted by Medicare and you're going to be successful. But if you're doing individual data for the three individual measures, you need 80%. But a good registry is going to do that scrubbing for you.

If you're going to do measures group – if you qualify for a measures group, you don't need 80%. You don't need 50%. All you need is 30 Medicare patients. That's it – 30 Medicare patients for the year that apply to that measures group.

All you have to do to be a successful reporter is to have 30 applicable Medicare patients and you can't have within that group a zero reporting. And it's absolutely wonderful. Thirty patients are so easy to get if you have a measures group that applies to you.

The zero reporting limit means CMS PQRS requires that at least one patient in the measures group has a positive response to that measures group to count the 30 patients unless of course the measures group is something called an “inverse measure”.

So for example, something like hemoglobin A1c where all zero reporting is a desired result, you want to have everyone to have a good hemoglobin A1c. Therefore, 100% zero is an acceptable reporting for that registry.

Get trained on more Physician Quality Reporting System coding and compliance topics at AudioEducator

Our Accreditation Partners
Facebook Twitter Linkedin Youtube RSS Feeds Google Plus