Physician Quality Reporting System (PQRS) 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.

View the 2012 PQRS requirements

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.

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

CMS list of eligible professionals (.pdf)

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.

CMS guidance regarding GPRO (.pdf)

The reporting requirements for satisfactorily reporting differ by your chosen reporting mechanism (i.e. claims based reporting, registry based reporting, 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 

View 2013 measure groups

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*
3. Elect to participate in the administrative claims-based reporting mechanism by October 15, 2013*

By choosing to avoid the 2015 payment adjustent via options 2 or 3, 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)

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