Healthcare Improvement Initiatives

Quality Data Reporting Systems

The Physician Quality Reporting System (PQRS, formerly PQRI) is a program established by the Centers for Medicare & Medicaid Services (CMS) in 2007. It is a voluntary program and creates a financial incentive for eligible professionals to report data on certain quality measures for Medicare Part B services.

As with other quality driven programs, Medicare requires that certain thresholds be met and that data is collected and reported. The reporting method is typically done by the use of a CPT II or "G" code submitted on the claim along with the other visit charges. In addition, there is an expectation that eligible providers are not only reporting data, but tracking it as well to view trends and make adjustments as needed.

Eligible professionals may participate in PQRS three ways:

  • To CMS on their Medicare Part B claims. This involves using your CMS-1500 form and adding the CPT II code or "G" code accordingly.
  • To a qualified PQRS registry. Eligible professionals must use a CMS-approved registry, which then captures and stores the data. The registry is responsible for submitting the measure information to CMS and calculating performance rates on behalf of the eligible professional. Providers may submit data to the registry at any time during the reporting period or up to one month afterward.
  • To CMS by means of a qualified electronic health record (EHR) product. Providers may submit quality reports through their office/facility's EHR if it is on the list approved by CMS.

The overall aim of PQRS relates to the push of CMS to start paying for quality outcomes versus volume of patients seen. This falls directly in line with the overall goal of your Center for Quality Improvement and how we can assist you in reaching positive quality outcomes.