Physician Quality Reporting System (PQRS)

What does PQRS stand for in healthcare compliance?
PQRS is an acronym that stands for Physician Quality Reporting System. 

 

What is a Physician Quality Reporting System (PQRS)?
The Physician Quality Reporting System, formally known as the Physician Quality Reporting Initiative, is a reporting program that encourages healthcare professionals to submit quality data to the Centers for Medicare and Medicaid Services. After submitting reports on healthcare professional quality, eligible professionals receive feedback reports from the Centers for Medicare and Medicaid Services. 

Before 2015, monetary incentives were used to motivate healthcare professionals to submit the quality measure data to the Centers for Medicare and Medicaid Services. However, after 2015 it became required that healthcare professionals submit quality data to the Centers for Medicare and Medicaid Services. If quality measure data is not reported to the Centers for Medicare and Medicaid Services, healthcare professionals are penalized.

How does a Physician Quality Reporting System (PQRS) work?
To use a physician quality reporting system, healthcare providers must determine whether or not the healthcare professional is eligible, find the best reporting method, figure out whether to report individual or group measures, and review the Physician Quality Reporting System (PQRS) Payment Adjustment information. According to the Spine Intervention Society, eligible professionals include the following:

  • Audiologists
  • Certified nurse midwives
  • Certified registered nurse anesthetists 
  • Clinical nurse specialists
  • Clinical psychologist
  • Clinical social worker
  • DC
  • DDS
  • DO
  • DPM
  • MD
  • Nurse practitioner
  • Nutrition professionals
  • OD
  • Physician assistant
  • Registered dietician 

According to the Centers for Medicare and Medicaid Services, methods that can be used to submit an individual healthcare professional’s quality report to the Centers for Medicare and Medicaid Services include the following:

  • EHRs using CEHRT (Certified Electronic Health Information Technology)
  • QCDR (Qualified clinical data registry)
  • PQRS registry
  • Medicare claims (Part B)
  • CEHRT through the data submission vendor

Methods that can be used to submit a group of healthcare professionals’ quality reports to the Center for Medicare and Medicaid Services can include the following:

  • Web interface
  • PQRS registry
  • EHRs using CEHRT
  • CG CAHPS that are certified by the Centers for Medicare and Medicaid Services
  • CEHRT through the data submission vendor

It is crucial to submit physician quality reporting system data to the Centers for Medicare and Medicaid Services; reporting this data helps ensure that a healthcare organization uses the correct electronic health record system, helps researchers better public health standards, and improves the care given to Medicare patients. 

MedTrainer is an all-in-one healthcare compliance software solution for Learning, Credentialing, Compliance, and much more. Package together your perfect custom solution. Visit the MedTrainer Compliance Corner to learn more about how MedTrainer makes healthcare regulation compliance easy.