PQRS in 2013
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 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 reporting.
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 practicioners, Audiologists, Qualified speech-language therapist
How Do I Register to Participate?
The PQRS registration site (PV-PQRS) is currently open through October 15, 2013 for providers to declare their 2013 PQRS reporting method. Providers can report on 2013 measures through February 28, 2014. Providers should ensure they have an Individuals Authorized Access to the CMS Computer Services (IACS) account prior to selecting their 2013 PQRS reporting method. The PV-PQRS website is also the place where individual eligible professionals (EPs) can select the administrative claims reporting option for CY 2013. Click here for step by step instructions on how to register.
Incentive Payments and Payment Adjustments
In 2013, 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.
*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.
How to Avoid the 2015 Payment Adjustment (Penalty)
1. Earn a 2013 PQRS incentive payment by satisfactorily reporting quality measure data
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.
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.
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 have 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 initial registration period closed on January 31, 2013. A second registration period will open later in 2013; CMS has yet to make details available, however, registration will close on October 15, 2013. Further details about the GPRO reporting requirements are outlined below.
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.
Alternatively, you can contact the Research and Quality Improvement unit for assistance at firstname.lastname@example.org