Alternative Reporting Mechanism

Eligible professionals do not have to enroll or file an intent to participate in the Physician Quality Reporting System. Professionals who choose to participate by reporting quality measures data through claims can simply report the appropriate quality-data codes on service lines of Medicare Part B Physician Fee Schedule (PFS) professional-services claims.

Beginning with the 2008 Physician Quality Reporting System program year, eligible professionals may also qualify to earn a Physician Quality Reporting System incentive by reporting quality measures data to a qualified registry. Professionals participating in a registry that self-nominates and qualifies to submit data on behalf of eligible professionals for a particular program year should expect to receive more information from the registry on how to participate.

In addition to the claims-based reporting mechanism and the registry-based reporting mechanism, an eligible professional may also be able to earn a Physician Quality Reporting System incentive payment through the Electronic Health Record (EHR)-based reporting mechanism.  Eligible professionals participating in the Physician Quality Reporting System utilizing a qualified EHR product should contact their qualified EHR vendor for additional details on submission. 

2013 Physician Quality Reporting System

2013 EHR Direct Vendor Qualified Posting

CMS is pleased to announce the 2013 Physician Quality Reporting System EHR Direct vendors and their systems (including specific version or release). These systems have been “qualified” to submit quality data to CMS by eligible professionals for the 2013 PQRS program year. Each of these EHR Direct vendors completed a thorough vetting process to verify that their system has the capability to provide the required data elements for the 51 PQRS EHR measures.  See the list of qualified vendors and additional information within the document titled “2013 EHR Direct Vendor Qualified Posting” in the “Downloads” section below.

2013 Physician Quality Reporting System

Documents for 2013 EHR-Based Reporting

CMS will accept PQRS quality measures data extracted from a qualified EHR product for a limited subset of 2013 PQRS quality measures. As stated in the 2013 PFS final rule, 51 measures are available for EHR-based reporting in 2013. The following documents for the electronic submission of these 51 measures  by eligible professionals using a "qualified" EHR are available in two ZIP files in the "Related Links" section below.  

Final Documents for 2013 EHR-Based Reporting

• 2013 EHR Documents for Eligible Professionals ZIP file containing:

- 2013 Physician Quality Reporting System (PQRS) EHR Measure Specifications – The detailed description of data element names and codes related to each of 51 2013 Physician Quality Reporting System quality measures available for electronic submission.

- 2013 Physician Quality Reporting System (PQRS) EHR Measure Specifications – Release Notes – The corresponding release notes for the 2013 EHR Measure Specifications.

- 2013 EHR Downloadable Resource Table

- 2013 EHR Downloadable Resource Table – Release Notes

• 2013  EHR Documents for Vendors ZIP file containing the 2013 EHR Data Submission Specifications and Release Notes v4.1. 

- 2013 CMS EHR QRDA Data Submission Specifications v4.1 

- 2013 CMS EHR QRDA Body Error Edits dated 07112012 

- 2013 CMS EHR QRDA Header Error Edits dated 04202012 

- 2013 CMS EHR QRDA Data Submission Error Edits Release Notes v4.1 

- 2013 EHR Downloadable Resource Table v4.1 

- 2013 EHR Downloadable Resource Table-Other Resource Codes dated Mar 2012 

- 2013 EHR Downloadable Resource Table Release Notes v4.1 

2013 EHR Direct Qualification Criteria for the 2013 Physician Quality Reporting System

The self-nomination and vetting process for EHR vendors for 2013 Physician Quality Reporting has been posted. This document describes the Qualifications for self-nomination including important deadlines. More information is available in the "Downloads" section below.

2012 Physician Quality Reporting System

2012 EHR Direct Vendor Qualified Posting

CMS is pleased to announce the EHR Direct vendors and their system and products (including specific version or release) that have been “qualified” to submit quality data to CMS by eligible professionals for the 2012 Physician Quality Reporting System program year. Each of these EHR Direct vendors has completed a thorough vetting process to verify that their system and product(s) has the capability to provide the required data elements for the 51 Physician Quality Reporting System EHR measures.  See the table and more information in the document titled “2012 EHR Direct Vendor Qualified Posting” in the “Downloads” section below.

2012 EHR Data Submission Vendor Qualified Posting

CMS is pleased to announce the EHR Data Submission vendors that have been “qualified” to submit quality data to CMS by eligible professionals for the 2012 Physician Quality Reporting System program year. Each of these EHR Data Submission Vendors has completed a thorough vetting process to verify they have the capability to provide the required data elements for the measures they intend to submit.  Some EHR Data Submission Vendors are also capable of reporting the electronic prescribing (eRx) measure to CMS. See the table and more information in the document titled "2012 EHR Data Submission Vendor Qualified Posting" in the "Downloads" section below.

2012 Data Submission Vendor XML File Specification EHR Aggregate

The Data Submission Vendor XML File Specification EHR Aggregate for program year 2012 has been posted to this section page.  To view click on document titled "2012 Data Submission Vendor XML File Specification EHR Aggregate" in the "Downloads" section below.

2012 Qualified Registries Posting Phase 2 

CMS is pleased to announce the registries that have successfully "qualified" to submit quality data to CMS on behalf of their eligible professionals for 2012 PQRS reporting. Each of these registries have completed the vetting process which includes providing the required PQRS data elements in an xml file submission, reviewing a measure flow and algorithms, performing use case calculations (this checks to see whether the registry calculates the measure's reporting and performance rates correctly). Some registries are also capable of reporting the electronic prescribing measure to CMS. See the table and more information in the document titled "2012 Qualified Registries Posting Phase 2" in the "Downloads" section below.

2012 Registry XML File Specification

The Registry XML File specification for program year 2012 has been posted to this section page.  To view click on document titled "2012 Registry XML File Specification" in the "Downloads" section below.

2012 Physician Quality Reporting System Medicare Electronic Health Record (EHR) Incentive Pilot: Quick Reference Guide. This Quick-Reference Guide provides direction to eligible professionals participating in the Medicare EHR Incentive Program on reporting and satisfying the CQM requirements through participation in the Physician Quality Reporting System-Medicare EHR Incentive Pilot. More information is available in the "Downloads" section below.

2012 EHR Direct Vendor Qualification Requirements for the 2012 Physician Quality Reporting Program Year

The self-nomination and vetting process for EHR vendors for 2012 Physician Quality Reporting has been updated. This document describes the requirements for self-nomination including important deadlines for qualification. More information is available in the "Downloads" section below.

2012 EHR Data Submission Vendor Qualification Requirements for the 2012 Physician Quality Reporting Program Year

The self-nomination and vetting process for EHR Data Submission vendors for 2012 Physician Quality Reporting will occur in 2012. This document describes the requirements for self-nomination including important deadlines for qualification. More information is available in the "Downloads" section below.

2012 Registry Submission Requirements

The self-nomination and vetting process for Registries for 2012 Physician Quality Reporting will occur in 2012. This document describes the requirements for self-nomination including important deadlines for qualification. More information is available in the "Downloads" section below.

2012 Physician Quality Reporting  Decision Tree.  This document contains a decision tree flow chart for 2012 reporting options.  This document is available in the "Downloads" section below.

Final Documents for 2012 EHR-Based Reporting

CMS will again accept Physician Quality Reporting System quality measures data extracted from a qualified EHR product for a limited subset of proposed 2012 Physician Quality Reporting System quality measures. As stated in the 2012 PFS final rule, 51 measures are available for EHR-based reporting in 2012. The following documents for the electronic submission of these 51 measures by eligible professionals using a "qualified" EHR is available in two ZIP files in the "Related Links" section below:

• 2012 EHR Documents for Eligible Professionals ZIP file containing:

- 2012 Physician Quality Reporting System EHR Measure Specifications - The detailed description of data element names and codes related to each of 51 2012 Physician Quality Reporting System quality measures available for electronic submission.

- 2012 Physician Quality Reporting System EHR Measure Specifications – Release Notes – The corresponding release notes for the 2012 EHR Measure Specifications.

- 2012 EHR Downloadable Resource Table

- 2012 EHR Downloadable Resource Table - Release Notes

• 2012 EHR Documents for Vendors ZIP file containing:

- Data Submission Specifications Utilizing HL7 QRDA Implementation Guide Based on HL7 CDA Release 3.0

- Updated EHR Data Submission Specifications Utilizing QRDA – Release Notes – Release notes for Data Submission Specifications Utilizing HL7 Quality Reporting Document Architecture Based on HL7 CDA Release 2.0

- 2012 EHR Downloadable Resource Tables - (2012 EHR Downloadable Resource Table and 2012 EHR Downloadable Resource Table – Other Resource Codes)

- 2012 EHR Downloadable Resource Table - Release Notes

- 2012 EHR Data Submission Specifications Utilizing QRDA Header Errors and Edits

- 2012 EHR Data Submission Specifications Utilizing QRDA Body Errors and Edits

NOTE: Previous Physician Quality Reporting System Program Year Documents

All previous program year documents will be moved to the appropriate program year section page at left.