Quality Payment Program: Reporting Patient Relationship Categories

August 8, 2019
Health Policy

Merit-based Incentive Payment System (MIPS)-eligible clinicians: The Centers for Medicare & Medicaid Services (CMS) released an article about reporting Patient Relationship Categories and Codes (PRC) on Medicare claims. Note: Reporting these codes will not affect reimbursement or have an impact on beneficiaries.

Voluntary Reporting Period: As of January 1, 2018, Medicare Part B MIPS-eligible clinicians may report patient relationships on Medicare claims using the PRC codes. While this will be mandatory in the future, it is voluntary during this initial period of implementation:

  • Participate to gain familiarity with the categories and experience submitting codes
  • CMS will review data on these codes to consider their potential future in cost measure attribution methodology

CMS proposed in the 2020 Quality Payment Program Proposed Rule that voluntary reporting of the codes would count toward the Improvement Activity performance category of MIPS for the 2020 performance year.