The Physicians Quality Reporting System (PQRS) codes are NOT part of Meaningful Use. However, beginning in 2013 their use is required in order to qualify for the Medicare stimulus incentive payments. At this time, PQRS applies ONLY to Medicare patients and Medicare billing.
The Physicians Quality Reporting System (PQRS) is an assortment of codes used for billing Medicare in addition to the standard CPT codes. The PQRS codes tell Medicare that you have performed specific functions in your practice. PQRS codes are also called G-codes or CPT II codes. ChiroSuiteEHR and its components of ChiroPadEMR and ChiroOffice are designed to make this task as smooth as possible for the office staff.
Use of the PQRS codes is mandatory for all Medicare providers beginning on January 1, 2015. Prior to that date it is “voluntary”. There are 3 major considerations:
1. As noted above, beginning on January 1, 2013 you CANNOT qualify for the Medicare stimulus incentive payments unless you are using the PQRS codes.
2. Using the PQRS codes in 2013 and 2014 will give you a bonus of 0.5% (that is half a percent) in your Medicare payments
3. If the PQRS codes are NOT used beginning on January 1, 2013 (yes, that is thirteen), then Medicare will reduce payments to you by 1.5% beginning on January 1, 2015. And the reduction in benefits will be increased each year for at least the following 2 years.
The PQRS codes tell Medicare that you are “meaningfully using” a certified electronic health record system to document each and every patient encounter (visit). In 2012 there were 3 categories of codes that were mandatory for use by Chiropractors. For 2013 only 2 categories are mandatory. A few other categories are required in order to comply with Meaningful Use. Some additional codes, although not required, should be used whenever you perform the service that they refer to.
PQRS codes are used in addition to the usual CPT codes and must appear on your billing as separate line items. Paper claims should show a zero (0.00) charge. Electronic claims must show a fee, such as 0.01 (1 cent) in order to get past many electronic clearing houses. Note that many clearing houses automatically delete any line item that has a 0.00 charge. When you submit electronically, there should be a TOSR discount set in the ChiroSuiteEHR system so that as the fees for PQRS are created, the discount can be entered with minimal staff effort. This will keep patient balances accurate.
The PQRS codes have alternative names. Some are called “G” codes, others are referred to as CPT II.