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How To Get Started

Step-by-Step Instruction in Getting Started with the Physician Quality Reporting System (PQRS)

Note: For guidance on how to report once across Medicare quality reporting programs (PQRS, EHR Incentive Program, Value-based Modifier, and Accountable Care Organizations), please see How to Report Once for 2015 Medicare Quality Reporting Programs.

STEP 1: Determine your eligibility

Find out whether you are eligible to participate in 2015 PQRS to avoid the 2017 negative payment adjustment. View our 2015 PQRS List of Eligible Professionals to determine your eligibility.

STEP 2: Determine whether you want to participate in PQRS as an individual eligible professional (EP) or as part of a group practice

  • Individual EPs are identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN).
  • A group practice under 2015 PQRS is defined as a single Tax Identification Number (TIN) with 2 or more individual EPs who have reassigned their billing rights to the TIN. Group practices can register to participate in PQRS via the group practice reporting option (GPRO) to be analyzed at the group (TIN) level. Note that group practices participating via GPRO are referred to as PQRS group practices.

STEP 3: Choose your reporting mechanism

Depending on whether you are participating in PQRS as an individual EP or as part of a PQRS group practice, you have several reporting mechanisms by which you can choose to submit your PQRS data.

Individual EPs may choose to report information on individual PQRS quality measures or measures groups using the following mechanisms: 

(1) Medicare Part B claims 
(2) Qualified PQRS registry

(3) Direct electronic health record (EHR) using certified EHR technology (CEHRT)
(4) CEHRT via
data submission vendor
(5)
Qualified clinical data registry (QCDR)

Group Practices may choose to report information on PQRS quality measures using the following mechanisms: 

(1) Qualified PQRS registry
(2)
Web Interface (for groups of 25+ only)
(3)
Direct EHR using CEHRT
(4) CEHRT via
data submission vendor
(5) CAHPS for PQRS via CMS-certified survey vendor (for group practices of 2+) to supplement PQRS group practice reporting

STEP 4: Choose which quality measures to report

Individual EPs and PQRS group practices should choose at least 9 individual measures across 3 National Quality Strategy (NQS) domains or 1 measures group as an option to report on measures to CMS (with the exception of GPRO Web Interface). Individual EPs or PQRS group practices are also required to report one (1) cross-cutting measure if they have at least one (1) Medicare patient with a face-to-face encounter. Review the following supporting documentation for specific criteria to satisfactorily report on these two options.

Note: For PQRS group practices electing to report via the GPRO Web Interface, CMS will pre-populate the Web Interface with a sample patient population for all 17 of the GPRO Web Interface measures.

Individual Measures 

Measures Groups

 

The following documents can be found on the Measures Codes section page or by clicking on the following: 2015 PQRS Individual Claims Registry Measure Specification Supporting Documents zip file and the 2015 PQRS Measure List Implementation Guide zip file.

  1. 2015 PQRS Measures List
  2. 2015 PQRS Measure Specifications Manual for Individual Claims and Registry Reporting and Release Notes for instructions on how to report claims-based or registry-based individual measures. Just print the pages for the measure specifications you are reporting as the document is very lengthy.
  3. 2015 PQRS Quality-Data Code (QDC) Categories
  4. 2015 PQRS Individual Measures Single Source
  5. 2015 PQRS Implementation Guide, which describes important reporting principles for all mechanisms of PQRS reporting and includes Decision Trees on reporting to avoid the payment adjustment.      
  6. 2015 Cross-Cutting Measures List for broadly applicable measures that are defined as cross-cutting
  7. 2015 PQRS List of Face-to-Face Encounter Codes, reference for the billable codes that identify face-to-face encounters for the purposes of 2015 PQRS reporting

The following documents can be found on the Measures Code section page or by clicking on the 2015 PQRS Measure Groups Supporting Documents zip file.

  1. 2015 PQRS Measures List
  2. 2015 PQRS Measures Groups Specifications Manual, for registry-based reporting of measures groups. Just print the pages for the measure specifications, including the measure group denominator coding, you are reporting. Note that the specifications for a measures group are different from those for individual measures because they identify a common denominator across the measures group. Be sure you use the correct specifications.
  3. Getting Started with 2015 PQRS Measures Groups is the implementation guide for reporting measures groups.
    • For 2015, PQRS measure groups are reportable via registry only.
  1. 2015 Quality-Data Code (QDC) Categories
  2. 2015 PQRS Measures Groups Single Source
  3. 2015 PQRS Measures Groups Release Notes
  4. 2015 Cross-Cutting Measures List for broadly applicable measures that are defined as cross-cutting
  5. 2015 PQRS List of Face-to-Face Encounter Codes, reference for the billable codes that identify face-to-face encounters for the purposes of 2015 PQRS reporting

STEP 5: Review PQRS Payment Adjustment information

Individual EPs and group practices who do not satisfactorily report data on quality measures for covered professional services will be subject to a negative payment adjustment under PQRS beginning in 2015. The PQRS negative payment adjustment applies to all of the EP’s or group practice’s Part B covered professional services under the Medicare Physician Fee Schedule (MPFS). Review information on the PQRS Payment Adjustment page for complete information on how to avoid future PQRS payment adjustments.

STEP 6: Review the PQRS Timeline

Plan ahead! View the 2015-2017 PQRS Timeline to keep track of PQRS-related milestone dates and corresponding resources.

Need Assistance?

Contact the QualityNet Help Desk for help with:

  • General CMS PQRS information
  • Portal password issues
  • PQRS/eRx feedback report availability and access
  • PQRS-IACS registration questions and login issues

Monday – Friday; 7:00 a.m.–7:00 p.m. Central Time (CT)

Phone: 1-866-288-8912

TTY: 1-877-715-6222

Email: Qnetsupport@hcqis.org

Frequently Asked Questions (FAQs)

Visit our Physician Quality Reporting System FAQ page and enter keywords in the search box to find answers on "How do I get started" or any other area of the program on which you may have questions.

To view the 2015 PQRS program requirements, review the 2015 Medicare Physician Fee Schedule Final Rule.

PQRS Listserv

Stay informed about the latest PQRS news by subscribing to the PQRS Listserv.