Are You Receiving MIPS Credit for Your Quality Data on Claims?

Pull up a chair and kick up your feet because I've got a story about quality reporting via claims for you.

TMA recently received a call from a physician who — get this — was not receiving credit for the quality-data codes (QDCs) that her electronic health record (EHR) vendor was submitting through claims.

She had been reporting QDCs via claims for her quality measures for months, but her EHR vendor had not been adding the 1-cent line-item charge that ensures the QDC line isn't dropped when the claim is processed. 

TMA has confirmed with the Centers for Medicare & Medicaid Services (CMS) that the 1-cent charge is still required for quality reporting via claims now that the Physician Quality Reporting System (PQRS) is part of the Quality Payment Program (QPP). The requirement applies to EHR vendors who offer claims submission services and to all physician practices who submit quality data through Medicare Part B claims. 

TMA continues to press CMS for official guidance on all of the Merit-Based Incentive Payment System (MIPS) claims-based coding and reporting principles. Until that happens, TMA recommends physicians refer to this CMS guide for details. Most of the process is similar to what it was for PQRS, but physicians now must refer to the CMS quality measure specifications ZIP file to find the most up-to-date codes for the 2017 MIPS performance year. 

So if you participate in the QPP, here are some steps to help make sure your quality data codes are accepted:  

  1. Look for denial code N620 on your Medicare remittance advice statements. This code indicates your codes were transmitted to CMS claims history files. It does not confirm whether the measures were clinically appropriate. This is why reviewing the measure specifications before submission is vitally important.  
  2. Consult your EHR vendor, billing staff, or billing vendor to make sure you're getting credit for your quality reporting. Review the steps with them and ask about the 1-cent line-item charge so you don't lose credit and get a penalty. If the code is not showing up, your software could be dropping the line item from the claim before submission, it might not be programmed to recognize the measure code, or it might be trying to drop the line item to a separate claim file. The line item for the measure MUST be on the same claim form with the services provided on the date of service.  

For more information about quality reporting, contact the QPP Service Center by phone at (866) 288-8232 or by email, or visit the TMA MACRA Resource Center.

Action, Aug. 15, 2017

Last Updated On

August 14, 2017

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