PQRS is a CMS reporting program that uses a combination of incentive payments and penalties (payment adjustments) to promote reporting of quality information by physicians and other health professionals.

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.

PQRS Information

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Announcements
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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

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

*NEW* Slides from the PQRSWizard Tutorial presented on 1/28/2014 are available here.

View the 2014 Quality Measures

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.

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Who Can Participate in PQRS?
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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

The following professionals are eligible to participate in PQRS:

Medicare physicians

  • Doctor of Medicine 
  • Doctor of Osteopathy 
  • Doctor of Podiatric Medicine 
  • Doctor of Optometry 
  • Doctor of Oral Surgery 
  • Doctor of Dental Medicine 
  • Doctor of Chiropractic

Practitioners

  • Physician Assistant 
  • Nurse Practitioner* 
  • Clinical Nurse Specialist* 
  • Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant) 
  • Certified Nurse Midwife* 
  • Clinical Social Worker 
  • Clinical Psychologist 
  • Registered Dietician 
  • Nutrition Professional 
  • Audiologists 
  • *Includes Advanced Practice Registered Nurse (APRN)

Therapists

  • Physical Therapist 
  • Occupational Therapist 
  • Qualified Speech-Language Therapist 

Beginning in 2014, professionals who reassign benefits to a Critical Access Hospital (CAH) that bills professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based). To do so, the CAH must include the individual provider NPI on their Institutional (FI) claims.

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How Do I Register to Participate?
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The PQRS registration site (PV-PQRS) is not yet open to providers wishing to declare their 2014 reporting method. 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.

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Incentive Payments and Payment Adjustments
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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
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How to Earn an Incentive Payment
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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 the reporting period.   

View the 2014 Quality Measures

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Avoiding the 2015 Payment Adjustment (Penalty)
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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

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PQRSWizard Online Registry
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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. 

Slides from the PQRSWizard Tutorial presented on 1/28/2014 can be found here.

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 2014 reporting criteria. 

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

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Who Can Help Me With PQRS Reporting?
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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 atqualityimprovement@entnet.org