PQRS, or the Physician Quality Reporting System, is a program implemented for reporting purposes under Medicare Part B. This voluntary program provides incentives to practices who employ eligible professionals (EPs), as identified by an NPI (National Provider Identifier) and TIN (Tax Identification Number). By reporting data on services to Medicare Part B Fee-for-Service beneficiaries, EPs will receive payment incentives in return for quality reporting on particular services. This program, started in 2006, has been reassessed over time. In 2015, PQRS policies will change again. In the coming year, payment adjustments will also be assessed to encourage participation by EPs by reporting specific quality measures.
About Changes to PQRS in 2015
Up until this point, PQRS has been a voluntary program, providing incentives to those who choose to participate. Starting in 2015, a penalty will be assessed, amount to 1.5% based on reporting from 2013. EPs who choose not to participate will be penalized at this rate. To avoid this penalty, EPs have two options.
- Submit data through approved areas including Medicare Part B claims, qualified registry, direct electronic health record (EHR) using certified EHR technology (CEHRT), CEHRT via Data Submission Vendor, or Qualified Clinical Data Registry among others. Submissions coming from these areas are eligible to receive incentives.
- By choosing to submit administrative claims directly to CMS for processing, EPs can avoid penalties, but incentives will be eliminated as well.
Quality measures are assessed on an annual basis. According to CMS, in 2015, these measures will likely include care coordination, patient safety and engagement, clinical process/effectiveness, and population/public health. EPs need not report on all measures, but can choose selectively based on relevant factors as outlined by CMS:
- Clinical conditions, which are commonly treated
- Types of care delivered frequently – e.g., preventive, chronic, acute
- Settings where care is often delivered – e.g., office, emergency department (ED), surgical suite
- Quality improvement goals for 2014
- Other quality reporting programs in use or being considered
For those practices who qualify, Feedback Reports are available upon request. These reports are available to EPs reporting PQRS quality measures and include reporting rates, clinical performance, and incentives earned.