user quick guide pqrs user's guide introduction to pqrs

Copyright 2012, Bizmatics, Inc. 4020 Moorpark Avenue, Suite 115, San Jose, CA 95117 (408) 873-3032

User Quick Guide PQRS User’s Guide

Introduction to PQRS PQRS (Physician Quality Reporting System) is a voluntary program which provides a financial incentive to eligible professionals (EP) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B beneficiaries. This incentive is applicable only for Medicare recipients, including Railroad Retirement and Medicare Secondary Payer claims. PQRS is mandated by federal legislation. Regulations/measures are published in the Federal Register and implemented by CMS accordingly. Eligible professionals are not required to sign-up or register for their participation in the program; however, incentive payments to such a provider are based upon the satisfactory compliance and reporting of required data for a particular reporting period. To view the qualifications of eligibility, please visit the CMS website --> Downloads section at: http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs/

Note: The Physician Quality Reporting program requirements and measure specifications for the current program year may be different from those of a prior year. Eligible professionals are responsible for ensuring that they are using the correct PQRS documents for the current program year. Participating individual eligible professionals may choose to report information on individual PQRS measures or measures groups to CMS via their Medicare Part B claims or via a qualified EHR product or to a qualified PQR registry or data submission vendor. For satisfactory submission of such measures, the EP will qualify to earn an incentive payment equal to 0.5% of their total estimated Medicare Part B PFS for allowed charges of covered professional services furnished during the reporting period. A participating group practice may also potentially qualify to earn PQR incentive payments equal to 0.5% of the group's total estimated Medicare Part B PFS for allowed charges of covered professional services furnished during the reporting period based upon the group practice meeting the criteria as specified by CMS. Click on the "Group Practice Reporting Option" link at left to learn more about this reporting option. For more information regarding group eligibility, please visit: http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Group_Practice_Reporting_Option.html

Figure 1 – CMS --> PQRS Home Page

http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs/

http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Group_Practice_Reporting_Option.html



Setting up the PQRS Master Defining PQRS within PrognoCIS requires some setup. There is a PQRS Measures master file under the configuration menu. Users with permissions to this master file will have the ability to define each measure as Active or Inactive based upon local requirements. Inactive measures will be excluded from all PQRS Reporting although they will be present in the master file.

Figure 2 – Settings --> Configuration --> PQRS Measures

Viewing PQRS Measures All quality measures defined by CMS as part of the PQRS program will initially be available within your PQRS Measures master file. You can then deactivate any measures you do not want to report by chang- ing the status to Inactive. Upon saving these changes, only the Active ones will remain by default.

Figure 3 – PQRS Measures Master File



Viewing a List of all PQRS Measures Measures are sorted by the Measure # as defined by CMS and status and are displayed in the following columns:

Measure # - a unique identifier assigned to the measure by CMS for easy reference.

Measure Name – the name assigned to the measure by CMS which describes the clinical activity being measured.

Category – a 3-digit classification for the measure, which corresponds to the clinical activity being measured (i.e.: DBM = Diabetes Mellitus, POC = Preoperative Care, CKD = Chronic Kidney Disease, etc.). For practices where there are multiple specialties, a provider may select only relevant categories to apply for his or her PQRS Reporting. Note: Hovering the mouse pointer over a category will display a tooltip with the full description for that category.

Status – defaults to Active; however, the user can change by clicking .

Applicable Codes – clicking the info button displays a popup that lists the specific criteria for the measure, including the Age, Gender, ICD, and CPT/HCPC codes that are considered.

Viewing a Measure’s Denominator Criteria The Denominator criteria for each individual measure may be viewed by clicking the info button for the measure, which displays a pop-up window that itemizes the various ICD and CPT/HCPC codes for the specified Age and Gender that will be included on the report. This information is defined by CMS and is displayed for your information only. It cannot be modified.

Figure 4 – Denominator Criteria



Assigning PQRS to a Provider by Category Each provider within the practice may select personal measures to be applicable for his/her reporting purposes based upon specialty. This is especially beneficial in a multi-specialty practice. This setup is done by associating the applicable PQRS Categories to the provider.

Figure 5 – Provider Master

1. Select Settings --> Configuration --> Medics --> Providers. 2. Select the applicable provider.

3. Click to select PQRS Category, which will display a pop-up

Figure 6 – PQRS Category Selection



4. Select applicable categories by clicking in the check box of each one. 5. Click the ok button. The selected categories will now display on the Provider record.

Figure 7 – Specified PQRS Categories for selected Provider

6. Click the save button.

Note: If no specific categories are selected, then all PQRS measures will be applied to the provider when the PQRS Report is generated.

PQRS Encounters PQRS is applicable only for Medicare encounters, as indicated by the patient having Medicare on their Patient Insurance. The menu option can be added to the Encounter TOC menu through Settings --> Configuration --> Admin --> Properties --> Encounter TOC Parameters.

Figure 8 – Medicare Encounter (Open)

On a Medicare encounter, the menu label on the TOC will display in white font and will change to yellow once it has been selected (see left sample below). For all other encounters, the label will be grayed-out as seen in the right sample below.

Figure 8 – Encounter TOC --> PQR

During the clinical documentation on the encounter, PrognoCIS is tracking the applicable indicators in the background based upon the Attending Provider’s defined PQRS Categories. Once the encounter has been completed, the provider can view the data to ensure it has been properly documented prior to generating the PQRS Report and submitting it to Medicare.



Validating an Encounter After applicable documentation has been saved (i.e.: Face Sheet, Templates, Assessment and Plan, etc.), the PQRS measures can be verified by reviewing them under the TOC --> PQRS screen. This screen will list all active measures associated to the provider and its status with regards to PQRS compliance for that individual encounter. If necessary, changes may be made directly from this screen.

Figure 9 – Encounter PQRS Results

PQRS Screen Action Buttons

Info – displays the Denominator criteria for the measure (i.e.: age, gender, ICD, and CPT/HCPC).

ICD – displays a list of all valid ICD Codes for the specific measure and allows you to select the one(s) that is appropriate for the encounter.

Figure 10 – Assign ICD



CPT/HCPC – displays a list of all valid CPT/HCPC Codes for the specific measure and allows you to select the one(s) that is appropriate for the encounter.

Figure 11 – Assign CPT/HCPC

Once an appropriate code or codes has/have been selected and saved, the background of the

Individual row for the measure will display in a light yellow color.

Figure 12 – ICD Selected for a Failed Measure

Upon clicking the save button, the system revalidates the encounter with the newly-assigned

code(s) and refreshes the status to indicate PASS or if errors remain.

Figure 13 – Updated Status after adding codes



PQRS Screen Data Columns

Category – a 3-digit classification which corresponds to the clinical activity being measured (i.e.: DBM = Diabetes Mellitus, POC = Preoperative Care, CKD = Chronic Kidney Disease, etc.). Note: Hovering the mouse pointer over a category will display a tooltip with the full description for that category.

Measure # - a unique identifier assigned to the measure by CMS for easy reference.

Measure Name – the name assigned to the measure by CMS which describes the clinical activity being measured.

G-Code – allows you to view the Numerator criteria and select the appropriate G-code for the measure which will add it to the encounter’s Assessment.

Status – indicates whether or not the encounter documentation is compliant for the measure. o FAIL – indicates the encounter is missing one or more of the required codes is missing as

well as which type of code(s) – i.e.: ICD, CPT, or HCPC. o PASS – indicates the encounter contains one or more of the required ICD, CPT, or HCPC

codes; however, if something else is missing; it will also be identified (i.e.: G-Code). Note: The G-code cannot be assigned until it has a status of PASS.

Assigning a G-Code to the Encounter

1. Click , which invokes the Charge Codes dialog window that displays all valid G-codes as supported within the selected measure.

Figure 14 – G-Code Assignment

2. Select the radio button for the desired code. 3. Click the ok button, which will update the G-Code column accordingly. In addition, the status

will update and indicate if it is passed or still has an error.

Figure 15 – G-code Assigned to a Failed Measure



Note: A G-code cannot be associated to a failed measure. The system will prompt that a valid ICD, CPT, and/or HCPC is required before a charge code can be associated.

Figure 16 – System warning on a Failed Measure

4. Click the save button, which will update the Assessment --> HCPC tab with the newly-assigned

G-Code. The Source will show as PQRS for audit purposes.

Figure 17 – Assessment Updated with G-Code

PQRS Report When applicable, a PQRS Report can be generated by Provider, Category, Measure, and/or Date Range.

Figure 18 – PQRS Report



Generating the PQRS Report By default, the system will generate the PQRS Report for all Medicare patients within the practice. However, it can also be generated by individual filters – i.e.: a specific provider, category or measure, as well as for a specific Patient if desired.

Figure 19 –

1. Select Report --> PQRS Report.

2. Click to select the applicable Doctor.

3. Select Category or Measure radio button then click to select the desired value.

4. Click to select the applicable Patient. 5. Specify the time Period (From / UpTo). 6. (Optional) Click the Sort button to defined desired sequence of data. 7. Click the ok button, which will generate the report.

user quick guide pqrs user's guide introduction to pqrs

Documents