What Is Quality Reporting?

Quality reporting is one category of the new Quality Payment Program and its sub-program, Merit Based Incentive Payment Program (MIPS). It generally consists of patient treatment and outcome information. The Quality portion of the MIPS program accounts for 50% of your Composite Performance Score (CPS) as a provider.

You can report Quality data to CMS in much the same way that you reported PQRS (from 2011-2016), using G-Coded claims (see note below). Or, you may choose to report Quality information through Clinical Quality Measures or CQMs, a method available through the Quality Center and the QPP Dashboard.

G-Coded Claims

Reporting Quality information by way G-coded claims is described here. Once you are set up to do so, your reporting occurs every time you file a Medicare claim.

IMPORTANT:  If you are reporting as a group through an assigned TIN, you cannot not use the G-coded claims option for reporting.

 

Clinical Quality Measures

Reporting Quality information though CQMs consists of assessing your patient’s healthcare and lifestyle choices and intervening where appropriate. When a patient treated during the reporting period falls within a certain demographic, and the appropriate diagnosis for the visit is added—or a particular diagnosis is used, a denominator is created. Once the required action is taken for that patient relating to the demographic or diagnosis, a numerator is created in return. This completes your Quality Compliance for that patient.

Generally, you would strive to place over 20 patients in the denominator and complete this compliance (generating a numerator) for these 20 or more, as this is the required minimum for scoring these measures. However if this not possible due to your scope of practice, CMS will score you on any cases submitted once their measures validation is completed.