The Physician Quality Reporting System (PQRS) is a voluntary reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). EPs report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).
PQRS was introduced by CMS in 2006. Each year the rules, measures, incentives, and payment adjustment change.
The incentives for PQRS reporting are:
- 2013: +0.5%
- 2014: +0.5%
No PQRS incentives are scheduled past 2014.
The payment adjustments for non-reporting are:
- 2015: -1.5% based on 2013 reporting
- 2016: -2.0% based on 2014 reporting
- 2017 and thereafter: -2.0% based on a 2-year look-back period
Step 1: Are you eligible for the PQRS Incentive Program?
Eligible Providers include most physicians, podiatrists, optometrists, dentists and chiropractors, as well as practitioners and therapists. A complete listing of eligibility requirements can be found here.
Step 2: Determine which PQRS reporting method best fits your practice. CMS has published a visual Decision Tree to help you. There are four methods of reporting to earn an incentive in 2013. These methods are: Claims , Qualified Registry, Qualified EHR (Direct and Data Submission Vendor), and the Group Practice Reporting Option (GPRO). In addition for 2013 only, you may avoid a 2015 payment adjustment—but not earn an incentive–by reporting PQRS using Administrative Claims.
If you are a provider that is participating in the EHR Incentive Program (i.e., Meaningful Use), you may find it valuable to submit PQRS using your EHR (either Direct or a Data Submission Vendor) if it is qualified. Doing so will help you develop skills that will be required to submit Clinical Quality Measures for 2014 Meaningful Use and PQRS.
Step 3: Decide if you’ll report Individually or as a Group. Groups are defined as 2 or more EPs operating under the same Tax Identification Number (TIN). Groups of 100+ EPs must report PQRS as a Group in 2013 to avoid Value-Based Modifier payment adjustments in 2015. Groups with 2-99 EPs may elect to report PQRS as a Group or as Individuals. Group reporters must establish an Individualized Authorized Access to CMS Computer Services (IACS) account and self-nominate between July 15 and October 15 via the CMS PV-PQRS Registration System. Individual reporters do not have to self-nominate nor register unless they elect to report PQRS using Administrative Claims. For more information on the PV-PQRS Registration System and IACS accounts, please view this webinar. Providers may contact the Quality Net Help Desk for assistance: 866-288-8912 TTY/TDD at 877-715-6222 (Monday – Friday 7:00 a.m.-7:00 p.m. CST) email at email@example.com.
Step 4: Understand the specific requirements to earn an incentive for the method of reporting you’ve selected.
To earn a PQRS incentive in 2013, you must achieve one of the following:
- Individual EPs:
- Report at least 3 measures for 50% of eligible Medicare Part B FFS patients, OR
- Report 1 Measures Group for at least 20 Medicare Part B FFS patients
- Qualified Registry:
- Report at least 3 measures for 80% of eligible Medicare Part B FFS, OR
- Report 1 Measures Group for at least 20 patients, the majority of which must be Medicare Part B FFS patients
- Qualified EHR Direct or Data Submission Vendor:
- Option 1: Report at least 3 measures for 80% of eligible Medicare part B FFS patients, OR
- Option 2: Participate in the PQRS-EHR Incentive pilot (3 core plus 3 menu measures that are also measures in the EHR Incentive Program)
- Groups (GPRO)
- Registry, Groups 2+ EPs: Report at least 3 measures for 80% of eligible Medicare Part B FFS patients, OR
- GPRO Web Interface:
- Groups 25-99 EPs: Report all measures for the first 218 consecutively assigned beneficiaries, OR
- Groups 100+ EPs: Report all measures for the first 411 consecutively assigned beneficiaries
Step 5: Understand how you can avoid a payment adjustment in 2015 (based on 2013 reporting). Requirements to avoid a payment adjustment are less stringent than to earn an incentive. To Avoid a Payment Adjustment:
- Option 1: Meet the requirements for satisfactorily reporting for the 2013 PQRS incentive payment (Individuals or GPRO, as discussed in Step 4), OR
- Option 2: Report one valid measure:
- Individuals: Report at least one valid measure or measures group via claims, qualified registry, or qualified EHR
- GPRO: Report at least one valid measure via qualified registry or Web-Interface, OR
- Option 3: Elect to participate in CMS-calculated Administrative Claims (Individuals or GPRO). Individuals and Groups electing Administrative Claims must Register in the CMS Portal prior to October 15, 2013 (see Step 3 above).
For detailed requirements, instructions and measure specifications, please refer to the following links:
- Claims-Based reporting
- Registry-based Reporting
- EHR-Based Reporting (Direct and Data Submission Vendor)
- Group Practice Reporting Option (GPRO)
Primaris is providing assistance to Missouri providers with reporting PQRS measures in 2013. Missouri providers may contact Sandy Pogones at Primaris email: firstname.lastname@example.org phone (573) 673-4531.
Providers may also contact the Quality Net Help Desk for assistance: 866-288-8912 TTY/TDD at 877-715-6222 (Monday – Friday 7:00 a.m.-7:00 p.m. CST) email at email@example.com.