PQRS vs. CQMs—What’s the Difference and How Do I Report Them?

There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they still don’t), and how to report the correct information.

A (Brief) History

The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.

Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.

A Confluence of Program Changes

Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA.

Additionally, CMS currently requires a full year of quality reporting under both programs in 2015.

All of these changes are happening just as the programs transition from paying providers incentives for participating, to subjecting providers to penalties for not participating.

Staying Afloat

Amidst the tidal wave of changes, many brave providers have tried to embrace the new electronic submission—without success. CMS is rejecting many electronic submissions. Looming deadlines and potential penalties have made providers anxious and frustrated. What can you do to stay on course?

PQRS Submissions: Fortunately, CMS is still allowing claims-based reporting for PQRS. Continue to drop those level II CPT codes on your Medicare claims through 2015 to avoid the penalty in 2017, just like you did last year to avoid the 2016 penalty.

Meaningful Use Submissions: CMS is also still allowing providers to manually enter their CQM numerators, denominators, and percentages in the attestation system for their 2014 meaningful use. If you haven’t attested to meaningful use yet, do so by February 28 and select the option to enter your CQMs manually.

If you have already attested to meaningful use, but you’re stuck because CMS can’t receive your QRDA file, go back into the attestation system and select the option to manually enter your CQM data. If you already submitted your attestation, call CMS and ask them to reopen your 2014 attestation so you can enter the CQMs manually.

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