What happens if you forget to add a PQRS code?
PQRS stands for the Physician Quality Reporting System. It is a health care quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States in 2006.
Medicare is moving towards a Pay-for-Performance structure where quality care should have quality outcomes. Medicare will compare your care to the care of your peers. If your care takes twice as many visits as other providers for the same diagnosis, then that will raise a red flag with Medicare for you.
A PQRS code must be appended to a billable service. They can not go out on a claim on their own, especially after the insurance claim has already been accepted. In addition, you can’t add it to a corrected claim if you forgot to add it the first time. It must be added in the first claim submission.
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