Physician Quality Reporting System (PQRS)
The Centers for Medicare and Medicaid Services Physician Quality Reporting System (Physician Quality Reporting or PQRS) is a reporting program that uses a combination of incentive (bonus) payments and payment adjustments (penalty) to promote reporting of quality information by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily 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).
Beginning in 2015, the program also applies a payment adjustment of -1.5 percent to eligible professionals who do not satisfactorily report data on quality measures for covered professional services. IMPORTANT: In order to avoid the 2015 negative penalty, you must report data on quality measures in 2013..
Read more about PQRS penalties for non-participation.
To participate in Physician Quality Reporting, individual eligible professionals may choose to participate individually or as a group. Those who choose to participate individually must report on individual Physician Quality Reporting quality measures or measures groups through Medicare Part B claims, a qualified Physician Quality Reporting registry, or a qualified electronic health record. (EHR) Those who choose to participate as a group can only report individual measures using a CMS-qualified PQRS registry or for groups of 25 plus eligible professionals through a web interface.
The criteria for obtaining an incentive for 2013 is as follows:
- Claims based—50 percent of applicable part B patients
- RegistryRegistryRegistryRegistry based—80 percent of applicable part B patients
- EHR based—80 percent of applicable part B patients
CMS Physician Quality Reporting System PQRS (2016) Informal Review Process
EPs, CPC practice sites, PQRS group practices and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit a request for an informal review. All requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available Sept. 9 through Nov. 9, 2015 under the “Related Links” section of the Physician and Other Health Care Professionals Quality Reporting Portal.
Note: “How to Request an Informal Review of 2014 PQRS Incentive Eligibility and 2016 PQRS Negative Payment Adjustment” will be available soon in the Analysis and Payment section of the PQRS website for more information.
Radiologists embrace PQRS
New blog post notes that interventional radiologists are leading the radiology pack when it comes to participation in the Physician Quality Reporting System (PQRS).
PQRS Interim Feedback Dashboard
Individual eligible professionals who have reported at least one PQRS quality measure this year via claims-based reporting can now view first quarter data regarding submissions, using the 2014 PQRS Interim Feedback Dashboard. You can access this dashboard through the Physician and Other Health Care Professionals Quality Reporting Portal