What is the methodology for PQRS scoring?
CMS has defined a numerator and a denominator that permit the calculation of the percentage of patient visits that achieve appropriate reporting of quality measures. There are 4 elements that must be extracted from the record to determine if the encounter qualifies for a PQRS measure: insurance status, patient age, ICD-9 code(s) and CPT code(s). The following is the step-by-step process that your biller would use to document Quality Measure #28 on the CMS 1500 billing form. First, the biller would determine the insurance status and age of the patient.
