Primary Source Verification Paper

Physician Quality Reporting System (PQRS), Program Measure Validation
Process - Primary Source Verification (PSV)

The Centers for Medicare and Medicaid Services (CMS) has contracted with Arch Systems (Arch) to perform measure-specific validation for the Physician Quality Reporting System (PQRS)/Electronic Prescribing (eRx) Incentive Programs. The measure validation process is called Primary Source Verification (PSV) and was developed under CMS’ guidance as part of the agency’s efforts to improve data quality for the PQRS and eRx Programs. Accurate data is important as measure results are used for physician payment and will be publicly available on the Physician Compare website. Additionally, providers need reliable data to use for quality improvement within their practices. Participation in the PSV program is voluntary but will help identify errors, if any, and improve accuracy of EP reported data and measures.

The PSV process will provide CMS with information on the overall rate of reporting error for PQRS and eRx, and to identify measures or measure types for which reporting errors are most prevalent and the most common sources of those errors.

The PSV process of verifying clinical data and measures involves the EP’s and is comprised of two phases: EP Selection, and Chart Review.

• EP Selection: EPs whose data is inconsistent with norms or not comparable to other claims information may be selected for PSV evaluation. Each EP in the sample has one reported measure, which has been identified as having EP-specific risk of error.

• Chart Review: EPs or their representatives are contacted, charts are selected from statistically generated samples, and nurse reviewers work with the EPs to validate chart accuracy and performance measures for the sample set.

During the PSV process (not to exceed 45 days for an EP), nurse reviewers from Arch work with EPs and/or their designated representatives to verify medical chart data. PSV results are categorized into three levels of compliance—High, Medium, or Low—and explained in detail to the EP. All results, analysis of data, and recommendations are then reported to CMS along with recommendations on how to improve the accuracy of PQRS data and the quality of PQRS/eRx reporting.

The PSV process is conducted yearly and generates data useful in improving measures, identifying the causes of errors, and verifying accuracy. Currently the PSV team is working with EPs to validate data based on analysis of 2013 PQRS and eRx Program results. The 2013 PSV process is applicable only to services furnished between January 1, 2013 and December 31, 2013.

For 2015, EPs identified to participate in the PSV program will be contacted by Nurse Reviewers from Arch Systems on behalf of CMS from February 25^th through July 19^th. The Nurse Reviewers will identify themselves and provide a detailed information package and assistance with completing the process.

For additional information, contact the CMS QualityNet Help Desk 1 (866) 288-8912 Monday - Friday;
7:00 AM-7:00 PM CT or at [email protected]. To verify the validity of a PSV contact, please email [email protected].