What is PQRS?
PQRS is not only the sequential letters in the alphabet, PQRS stands for the Physician Quality Reporting System. PQRS is a measurement system to judge the quality of care delivered by eligible medical professionals. PQRS started as an initiative in 2006 in the Tax Relief and Health Care Act (TRHCA) (P.L. 109-432).
TRHCA “required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-275) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). In 2011, the program name was changed to Physician Quality Reporting System (Physician Quality Reporting).” https://www.cms.gov/PQRS/
There are over 100 quality measures that are related to all medical specialties. The American Medical Association has congregated all of the quality measures and have listed them all on their website: http://www.ama-assn.org/apps/listserv/x-check/qmeasure.cgi?submit=PQRS
Now you are probably wondering what this means for medical billers. The PQRS standards are what qualifying professionals are paid for or would be paid for. As a medical biller you know that it is your job to get your boss or client paid. It would be advisable to review the PQRS standards for the specialties that you bill for so that you can make sure you maximize the reimbursement for Medicare patients.
