PQRS

The Physician Quality Reporting System (PQRS) is a quality assessment program run by the Centers for Medicare & Medicaid Services (CMS). While participation is voluntary, eligible professionals can avoid penalties and earn incentives on Physician Fee Schedule services provided to Medicare Part B Fee-for-Service beneficiaries. The gap between reporting versus ignoring PQRS can add up to 8% to your Medicare Part B reimbursements. Furthermore, participation provides practices with an opportunity to assess and enhance their Quality of Care.

​Eligible Professionals

Professionals eligible for the program include physicians, practitioners and therapists. They can select and report on the quality measures appropriate for their specialty. Providers can report as individual Eligible Professionals (EPs) or can participate in the Group Practice Reporting Option (GPRO). They can select individual measures or measure groups. CMS provides options for satisfactory reporting, which determine the measure criteria, how to pass validation, and potential validation adjustments. 

Penalties and Adjustments

Failure to report PQRS results in a penalty that reduces your reimbursement by up to 6% for solo practitioners and groups of 2 to 9 providers, and 8% of groups of 10 or more. In contrast, reporting results in a quality based adjustment ranging from -2% to 2%. Both penalties and adjustments are disbursed with a 2 year delay. For instance, the 2015 impact will be included in your 2017 reimbursements. 

The penalties and adjustments repeat annually and the difference in reimbursement will offset your investment in reporting satisfactorily. Furthermore, PQRS will provide you with insight into your Quality of Care, revealing areas your practice could further develop. Read more on penalties and adjustments

Finding a PQRS Registry

MeHI no longer offers a PQRS Registry and Support. A number of alternate options are available in the market. Visit the Qualified Registries list on the CMS website to search for a suitable registry.

To learn more about PQRS reporting, visit the CMS PQRS Registry webpage.

 

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