Select Health has released a new guide to help providers understand how penny claims can support quality reporting and when they may be appropriate to use. The QPP Penny Claims Guide includes examples, documentation requirements, and reporting codes for several quality measures, along with guidance related to additional diagnosis reporting for risk adjustment.
What is a penny claim?
A penny claim, also called a reporting-only or no-cost claim, is a non-reimbursable claim submitted with a $0.01 charge to communicate clinical information when there is no billable encounter. Penny claims help ensure important clinical data is captured through the claims system and reflected in the Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare & Medicaid Services (CMS) Star Ratings, and other quality reporting programs.
Why use a penny claim?
Penny claims can help:
- Capture clinical data obtained outside of an office visit
- Report qualifying exclusions or numerator events
- Improve HEDIS and Stars performance when documentation exists, but no billable encounter occurred
- Ensure data is available for quality reporting in a timely manner
- Reduce missed opportunities when services are completed, but not billed
When used appropriately, penny claims help ensure your clinic receives credit for care that has already been provided and documented.