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FAQs about Claims-Based Reporting

Claims-based reporting continues to be one of the options an Eligible Clinician can utilize to meet Medicare’s quality reporting requirements as we transition into the 2017 reporting year under MIPS and the new Quality Payment Program.

As with any other reporting method, claims-based reporting has its pros and cons. Our latest addition to our “Frequently Asked Questions” posts that you’ll find below, will answer some popular questions about claims-based reporting and how it compares to registry reporting.

Do you have questions about claims-based reporting? Simply add them in the comments section below and we’ll answer them for you!

Q. Is claims-based reporting for quality measures going away?

A. CMS continues to move away from claims based reporting as indicated by the continued reduction of claims measures. For example, of the 18 new measures in 2017, only 1 may be reported via claims. Currently, per the QPP website, there are 74 measures which may be reported via claims and 243 measures reportable via a Registry submission.

Q. What is a successful reporting rate for claims in 2017?

A. To optimize your quality score in 2017, “data completeness” is a reporting rate of 50% of your Medicare Fee for Services (FFS)/ Railroad patients for claims reporting. Registry reporting rate for data completeness is also 50% but registry submissions include ALL patients, regardless of insurance.

Please be aware in the MACRA proposed rule, the reporting rate was proposed at 80% for claims and 90% for registry. We anticipate the reporting rate will increase in the future.

Q. What does “repurposing” claims reporting mean?

A. We have the ability to translate performance (based on your submission of appropriate quality codes) from your billing files to a Registry submission. Although there are separate specifications for claims and Registry measures, the Quality Data Codes (QDC) track to the same performance. To streamline the process, Mingle Analytics has built an 837 utility that imports and processes your claims data for analysis.

Q. I notice that measures that are not reportable as Claims measures have claims codes assigned to them. What is that about?

A. Medicare recognizes that many measures are difficult to extract from a data system and are still best scored manually for performance. The claims or QDC codes are an effective way of communicating performance even if it does not directly pertain to a claims submission. Even after Medicare finally discontinues claims submissions they plan to continue to support QDC claims performance codes in the specifications as a solid and standard way of communicating performance to a reporting vendor.

Q. If a practice is only able to capture performance by adding quality data codes to their billing files, would they be able to report additional Registry measures with Mingle Analytics?

A. Yes! Your challenge might be capturing ALL payer data. We have heard from one client that submitting QDC codes to private payers has resulted in a denial of claims requiring reprocessing, other practices have had no issues with submitting quality codes to private payers. For practices who have experienced denials, scrubbing a file prior to insurance submission while preserving the file for performance analysis may be an option.

Q. What are the benefits to registry reporting?

A. There are many benefits to registry reporting, but we outlined a few of the major points below.

  • Registry reporting offers significantly more measures to choose from, allowing practices to more accurately capture the type of care they provide to patients.
  • Because registry measures report on all patients, regardless of payer, submissions have larger denominators per measure. This is important to consider because measures submitted with fewer than 20 eligible patients receive three points compared to the 3 to 10 points a measure could receive with greater than 20 patients.
  • With claims reporting, once the claim has been submitted, quality data codes cannot be added or changed. You cannot know your performance until Medicare calculates it. You can never correct or a submission in error or complete a submission that is incomplete. When you are reusing your claims submission to create a Registry submission, you can prepare, view, and edit your submission before it is finalized. Even after submission, it can be corrected and resubmitted up to the March 31 submission deadline. You can know your performance and compare it to Medicare benchmarks before your submission is final.

Contact us today for a free consultation with a member of our knowledgeable team. We will help all practices, small and large, find a quality reporting solution that is right for them.

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