The PQRS Page

An example the PQRS page containing the status for all the selected PQRS measures is shown below. 

Clinician

If you have multiple eligible professionals (or clinicians) in your practice, select clinician whose PQRS data you wish to see.

Note: users' whose access level to their Kalix account is Clinician or Supervisor, will only be able to see their own PQRS eligible encounters and measures. Directors and Administrators will be able to see all users' PQRS eligible encounters and measures, hence will have full access to PQRS. 

The Red Notification

You may see a red notification at the top of the page. This is to warn you of any previously created CMS 1500 claims (bills), which Kalix has identified as eligible for PQRS, but was not able to link to matching appointments. Below we will detail how to correct this. 

PQRS Measurements Table

The table on this page, list all PQRS measurements selected for your account. The measures that have errors (as shown in the error column) do not meet reporting and/or performance requirements or have associated encounters without recorded eligibility criteria, are highlighted a red color. There are also warnings associated with each measurement, displayed in the warnings column. The warnings relate to identified eligible encounters that do not have any PQRS measures associated with them.

The details of the errors and warnings associated with each measure, can be viewed by clicking on its row. 

Viewing Compatible Bills that are not Connected to an Appointment

As detailed above, there may be a red notification on the top of the PQRS page. This is to warn of you of any previously created CMS 1500 claims (bills), which Kalix has identified as eligible for PQRS, but has not been able to link to matching appointments. 

1. To view these bills, click on the View bills link as shown below. 

2. Kalix will then list the related bills. Click on the View link to edit a specific bill. 

3. The bill will open up. Click on the Details tab to view and edit the bill's details. 

4. On the bill Details page, we wish to look at the client subsection (shown below).

Remember, our goal is to associate (or link) an already created appointment with this bill.

Note: if an appointment does not exist, you can retrospectively create an appointment in Kalix's appointment calendar, click here for details.

5. You might see that the bill has already been associated with a referral as shown below. If this is the case, click on the Unlink link.

Alternatively, the bill may not be linked to a referral. 

6. Now we wish to link bill to it's associated appointment. Click on the Link to an existing appointment... Kalix will list previously created appointments. Click on the correct appointment to select and link.

7. The Appointment will be linked to the bill. If there is a referral associated with the appointment, (click here for details), Kalix will also automatically associate referral with the bill.

8. Now scroll down to the bottom of the page and click, save.

The Encounter is now ready for the imput of PQRS data. Open up the appointment's Appointment Details (Encounter) page to enter data.

The Specific PQRS Measure Page

Back on the PQRS page (see the section PQRS Page above for details) we are going to take a look at the PQRS Measure Page. This is the details page for a specific PQRS measure. 

  1. To view details about a specific PQRS measure, click on it's row. 
  2. The specific measure page will open up. 

An example page is shown below. This measure had two errors and one warning. These particular errors (on the example below), tell us that not enough information has been collected (reported) on this specific measure to pass PQRS requirements. Additionally, the clinician's performance on this measure doesn't meet requirements. 

The warnings table, lets us know that there is an existing encounter that is eligible for reporting (automatically identified by Kalix) but PQRS data on the selected measure is yet to be reported.

Note: to meet PQRS reporting requirements, measures should be recorded for least 50% of a clinician's Medicare Part B eligible encounters. Hence,to meet PQRS reporting requirements, you do not actually need to record PQRS data for every eligible encounter. This is why this missed encounter is displayed as a warning and not an error. A clinician could fail to record PQRS measures for this specific encounter (as long as information is recorded for other clients) and still meet reporting requirements. 

Let's look at another PQRS Measure Page, this time for Diabetic Foot and Ankle Care. Currently this measure does not have any eligible encounters. Kalix has identified that there are three encounters that could possibly be eligible, but the eligibility criteria has not been completed.

Note: eligibility criteria is used to determine whether a client encounter is eligible for recording a specific PQRS measure. All PQRS measures have specific eligibility criteria e.g. age of client, medical diagnosis, procedure code. Kalix tries to automatically complete eligibility criteria when possible. Sometimes there are eligibility criteria, Kalix cannot automatically complete e.g. that the client is not eligible for a extremity neurological exam because they are a bilateral amputee. When this is the case, you are required to tick a few select boxes to complete the eligibility criteria first, before the performance measures can be entered.

To complete the eligibility criteria, hence confirm that the encounter is eligible or not, click on the View Encounter link. 

The Appointment Details Page

After clicking on the View Encounter link, the Appointment's Details (Encounter) page will open up. An example is shown below. Kalix has automatically linked up the matching bill and selected the eligible PQRS measures based on the client's demographic (e.g. age, gender), appointment (e.g. date of appointment), referral (diagnosis ICD-10) and billing (CPT/HCPC codes) information. 

To complete the PQRS data for a particular measure, click on it's row.

Manually Enabling PQRS on an Encounter

If you have not created a bill for a specific appointment, you can manually make an appointment a PQRS valid encounter.

To do this first, you need to make sure that Medicare is assigned as the client's insurance, against the client's Details page, click here for details.

For Kalix to know that an insurance is Medicare, the insurance type must be assigned as Medicare (as shown below). 

Once this is done, on the Appointment's Details page, you can enable PQRS. 

There is a tickbox just below billing - Is PQRS valid encounter, click to enable PQRS. 

Before completing the PQRS data, you must also make sure that there is a referral linked to the encounter, click here for details. This is to add the diagnosis (ICD-10 code/s) to the encounter. 

There should be a bill linked to the encounter as well. Alternatively, the encounter's associated Billing code/s (CPT or HCPC code/s) can be entered on this page via the Billing Codes field.

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