Claims-based Reporting Mechanism

50.1 – Claims-based Reporting Mechanism (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) Eligible professionals who choose to participate in Physician Quality Reporting System via the claims-based reporting mechanism do not have to enroll or register with CMS to begin reporting Physician Quality Reporting System quality measures data to CMS. Participating eligible professionals whose Medicare patients fit the specifications of the Physician Quality Reporting System quality measures and/or measures groups will simply report on their claims the corresponding appropriate quality-data codes (QDCs), which are CPT Category II codes or G-codes (where CPT Category II codes are not yet available). CPT Category II codes and G-codes are Healthcare Common Procedure Coding System (HCPCS) codes for reporting quality data. Claims-based reporting may be via: (1) the paper-based CMS 1500 Claim form or (2) the equivalent electronic transaction claim, the 837-P.