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Physician Quality Reporting System (PQRS)


Physician Quality Reporting System (PQRS)

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What is PQRS ?
It is a program Physician of quality reporting that utilizes negative payment adjustments to report the information of quality by group practices and individual EPs. Those people who do not report data satisfactorily on the quality measures for Medicare Physician Fee Schedule will be subjected to negative payment adjustments under the PQRS system.
Eligibility Criteria For Participation In PQRS :
Therapists, practitioners, and medicare physicians who provide covered professional services that are based on the MPFS are considered as EPs under the PQRS. Most of the services that are payable under the fee schedules other than the MPFS are usually not included in the 2016 PQRS, these are not eligible for it. Also, the suppliers of durable medical equipment i.e. DME are not allowed and are not eligible to participate in the PQRS.
Reason To Participate In PQRS :
There are mainly two reasons :
● It helps to improve and enhance quality of healthcare, PQRS plays a very important role to facilitate the participation of physicians that are eligible in this process so as to improve the quality of healthcare.
● Reporting satisfaction to avoid 2018 PQRS negative payment, if you want to know more about it click on the link given below :
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index?redirect=/pqrs
Selecting measures in PQRS :
The quality measures are developed and made by quality groups, provider associations. CMS is used to assign the quantity that is based on a standard set designed and developed by the developers.
When you are selecting measures for reporting you should look onto some factors :
● Commonly treated clinical conditions.
● Different types of care that is delivered like for eg, chronic, acute, and preventive.
● Care is delivered or not in a proper way and where it is done like for eg, office, ED, surgical suite, etc.
● Quality reporting programs that are in use.
● Goals for quality improvement.

Program for Maintenance :

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There was a certification program in 2014 where EPs had the opportunity to earn the PQRS incentive. The additional incentive was paid of 0.5% for working with a maintenance certification entity.
For this the following was required :
● Satisfactory submission of data without any regard to method on the quality measures under PQRS for 12 months reporting period. You can do this by being a member of a group that is selected.
It also involves proper implementation of medical coding. If you don’t know what medical coding is then don’t worry I have got you covered.
What is Medical Coding :
Medical coding is a process in which transformation of Healthcare diagnosis, Medical Services and equipment occurs into the Universal medical alphanumeric codes. The diagnosis reports are taken from Medical records such as transcription of physicians notes, basically medical coding professional help to ensure that the codes are applied correctly during the billing process that usually include assigning the proper codes and to create a claim that can be paid by insurance carriers.
A career in medical coding is lucrative. If talking about the scope then, it is one of the fastest-growing fields in the healthcare industry having a global demand, so it is no surprise that there is definitely a great career in the field of Medical Coding in future.
If we talk about the salaries then, the salary for medical coding in India is on an average ₹ 420,000 per year or we can say about ₹ 215 per hour. For freshers, the salary starts from ₹ 290,625 per year, but if you are experienced enough, then your salary can go up to around ₹1,500,000 per year.

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Some other websites you might want to visit :
https://www.snmmi.org/ClinicalPractice/content.aspx?ItemNumber=10453
https://www.policymed.com/2013/10/pqrs-healthcare-providers-must-report-by-midnight-tonight-to-avoid-penalties.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077700/
https://www.findacode.com/medicare/pqrs/index.html
https://www.veetechnologies.com/industries/healthcare-provider/health-information-management-him/clinical-abstraction/physician-quality-reporting-system-pqrs-group-practice-reporting-option-gpro.htm


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