Physician Quality Reporting System (PQRS) 2013/2014

PQRS-Logo

The Physician Quality Reporting System (PQRS), a Center for Medicare & Medicaid Services (CMS) initiative, provides incentive payments and payment adjustments to physicians and other eligible professionals who successfully report data on quality measures. PQRS begins adopting payment adjustments (penalties) in 2015; however, the penalties will be based on participation during the 2013 reporting period.  The same is true for CY 2016, for which penalties will be based on performance in PQRS from CY 2014.

*NEW*Act now to avoid the 1.5% CMS penalty and become eligible for a 0.5% incentive! PQRSWizard deadline for 2013 reporting is March 13, 2014. 

*NEW* Slides from the PQRSWizard Tutorial that occurred on 1/28/2014 can be found here. An updated Q & A is being developed and will be available by February 14th, 2014.

*NEW* 2012 PQRS Feedback Reports Available

The Academy has produced a one page fact sheet to provide information on how you can successfully participate in PQRS and earn incentive payments based on 2013 & 2014 reporting. 

*NEW* View the 2014 PQRS Fact Sheet

and

View the 2013 PQRS requirements
View the 2014 PQRS requirements

*NEW* 2014 BOG Leadership Forum Presentation on Clinical Quality Measures  by Kate Goodrich, MD, Director of Quality Measurement and Health Assessment Group for CMS

 
Who Can Participate in PQRS?

Under Physician Quality Reporting System (PQRS), covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments.

Eligible professionals include: Medicare physicians, Physician assistants, Nurse practitioners, Audiologists, Qualified speech-language therapist

CMS list of eligible professionals (.pdf)

 
How Do I Register to Participate?
The PQRS registration site (PV-PQRS) is not yet open to providers wishing to declare their 2014 reporting method, however, providers can report on 2013 measures through February 28, 2014. (Providers choosing to utilize the PQRSWizard tool outlined below will have through March 13, 2014). Providers should ensure they have an Individuals Authorized Access to the CMS Computer Services (IACS) account prior to selecting their PQRS reporting method. Click here for step by step instructions on how to register.
 
Incentive Payments and Payment Adjustments

In 2013 and 2014, physicians and other eligible professionals who successfully report quality measure data can earn a 0.5% incentive payment on their total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period. Earning an incentive payment in 2013 will avoid the 2015 penalty adjustment. A list of current and future incentive and payment adjustments is provided in the table below.

Reporting Period

2013

2014

2015*

2016**

Incentive Amount

0.5%

0.5%

   

Penalty Amount

   

 -1.5%

 -2.0%


*The 2015 payment adjustment is based on PQRS participation during the 2013 reporting period
**The 2016 payment adjustment is based on PQRS participation during the 2014 reporting period
 
How to Earn a 2013 Incentive Payment

The reporting requirements for satisfactorily reporting differ by your chosen reporting mechanism (i.e. claims based reporting, registry based reporting such as the Academy's PQRSwizard, Electronic Health Record (EHR) reporting, GPRO), the quality measures you choose to report (individuals measures, measures groups), and your 2013 reporting period.   

2013 reporting requirements (.pdf)

View individual quality measures for 2013/2014

View 2013/2014 measure groups

 
How to Avoid the 2015 Payment Adjustment (Penalty)

1. Earn a 2013 PQRS incentive payment by satisfactorily reporting quality measure data
2. Report at least 1 measure via claims, registry, or qualified EHR OR report at least 1 measures group via claims or registry*

By choosing to avoid the 2015 payment adjustment via option 2, eligible professionals will not become eligible for a 2013 incentive payment. These options only avoid the 2015 payment adjustment. CMS has highlighted that these additional options will only be available during the 2013 reporting period.

CMS: Avoiding the 2015 payment adjustment (.pdf) 

*NEW* Changes to PQRS for CY 2014
The Academy is awaiting CMS' release of 2014 guidance documents and registration dates, and is still in the process of reviewing applicable measures for Otolaryngology reporting in CY 2014.  We have, however, prepared the following summary of the final 2014 PQRS reporting requirements and key changes to the program, including the inclusion of four new sinusitis measures and the creation of a new reporting method through Qualified Clinical Data Registries

 
PQRS Wizard

PQRSwizard is a fast, convenient, and cost effective online registry to help collect and report quality measure data for the PQRS incentive program. Similar to online tax preparation software, the PQRSwizard helps guide you through the steps to help rapidly collect, validate, report, and submit data to CMS for payment. The PQRSwizard is powered by the CE City Registry, a CMS qualified registry for PQRS reporting. 

Click here to access the PQRSwizard website and start reporting today. 

A recording of the November 19, 2012 PQRSwizard (formerly known as PQRIwizard) webinar is available online. The webinar provides an overview of PQRS and the PQRSwizard tool. 

*It is important to note that reporting criteria for the PQRS program has changed since the 2012 webinar was recorded, so please refer to the Academy's Fact Sheet above for 2013 reporting criteria. 

A set of questions and answers from the webinar presentation can be viewed here

PQRIwizard video image

Click here to access the recording. 



 
2012 PQRS Feedback and QRUR Reports Available

Physician PQRS Feedback Reports: If you participated in the Physician Quality Reporting System (PQRS) program between January 1 and December 31, 2012, you may now access feedback on your 2012 performance. Individual Eligible Professionals (EPs) can retrieve their 2012 PQRS Feedback Reports on the QualityNet website. QualityNet also provides information to assist physicians in interpreting data from their feedback reports. 

Physician Quality Resource Use Reports (QRURs): If your group participated in the 2012 PQRS Group Practice Reporting Option (GPRO), you can also now access 2012 Quality and Resource Use Reports (QRURs). Authorized representatives of your practices with 25 or more EPs can access the QRURs using an IACS account. More information about QRURs and the required IACS roles is available on the CMS Physician Feedback Program website under the Quality and Resource Use Report (QRUR) page.

 
Participating in PQRS under the Group Practice Reporting Option (GPRO)

For 2013, CMS revised their requirements for group practice reporting. Practices with two or more physicians or other eligible professionals can now participate in PQRS as a group. To participate in the group practice reporting option (GRPO) practices must self-nominate/register. The registration period closed October 15, 2013. Further details about the GPRO reporting requirements are outlined below.

CMS guidance regarding GPRO (.pdf)

 
 
Who can help me with PQRS reporting?

The CMS QualityNet Help Desk provides support for the PQRS program. The help desk can be contacted Monday - Friday from 7:00am to 7:00pm CST.

Phone: 1-866-288-8912

TTY: 1-877-715-6222

Email: qnetsupport@sdps.org

Alternatively, you can contact the Research and Quality Improvement unit for assistance at qualityimprovement@entnet.org