PQRS: How to Determine PQRS Eligibility
March 1, 2016
Written by Sarah Leake
The list of eligible professionals for the PQRS program is much broader than what you may be familiar with for Meaningful Use. PQRS eligible professionals (EPs) include Medicare physicians, practitioners and therapists. A complete list of eligible professionals and explanation of Medicare reporting can be found on the 2016 PQRS List of Eligible Professionals. Eligibility is focused around whether the provider or institution payment is based on the Medicare Physician Fee Schedule. Only those EPs who render denominator-eligible, Part B MPFS professional and/or institutional services are considered able to participate in PQRS. Billing can be via the CMS-1500 or 1450 claim forms or electronic equivalent. Remember that although your outpatient billing may not be subject to PQRS/VM penalties, you must also look at the method in which you bill your professional charges in your Critical Access Hospital.
NOTE If a clinician is deemed eligible to participate, then they are also subject to payment adjustments if they choose not to participate.
As usual, reporting for CY2016 applies to the PQRS payment adjustments in CY2018.
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