CMS to evaluate PQRS, eRx programs due to improper payments

Laura Pedulli | | Health Exec | Policy & Regulations

The Centers for Medicare & Medicaid Services (CMS) is looking to recoup payments after discovering that its Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) incentive programs are riddled with data integrity issues, such as rejected and improper payments.

In a March 17 Federal Register notice, CMS wrote that it will launch a four-year project to evaluate incentive payment information for accuracy and identify improper payments, with the goal of recovering those payments. This will involve:

  • An analysis of data submission, processing and reporting for potential errors, inconsistencies and gaps that are related to data handling, program requirements and clinical quality measure specifications of the PQRS and eRx programs; and
  • Surveys and limited follow-up interviews of group practices, registries and data submission vendors to evaluate the PQRS and eRx incentive programs.

The project also will develop recommendations to avoid future data integrity issues, according to CMS.

Laura Pedulli

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