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Physician Quality Reporting System

Payment Adjustment Information

Physician Quality Reporting System (PQRS) Payment Adjustment Information

Section 1848(a)(8) of the Social Security Act, as added by section 3002(b) of the Affordable Care Act, requires CMS to subject eligible professionals who do not satisfactorily report data on quality measures for covered professional services to a payment adjustment beginning in 2015.  The PQRS payment adjustment applies to all of the eligible professional’s Part B covered professional services under the Medicare Physician Fee Schedule (PFS).  Accordingly, eligible professionals receiving a payment adjustment in 2015 will be paid 1.5% less than the MPFS amount for that service.  For 2016 and subsequent years, the payment adjustment is 2.0%.

2015 PQRS Payment Adjustment

To avoid the 2015 PQRS payment adjustment, individual eligible professionals and CMS-selected group practices participating in the PQRS Group Practice Reporting Option (GPRO) will have to satisfactorily report data on quality measures for covered professionals services provided in 2013.  Reporting during the 2013 PQRS program year will be used to determine whether a PQRS payment adjustment applies in 2015.  The proposed criteria for satisfactorily reporting data on quality measures in 2013 to avoid the 2015 PQRS payment adjustment is detailed in the 2013 Medicare PFS Proposed Rule, which went on public display on July 6, 2012. The criteria for the 2016 payment adjustment is also proposed in the 2013 PFS proposed rule.  To view the 2013 PFS proposed rule, click on the "2013 Physician Fee Schedule Proposed Rule -- CMS-1503-P" in the "Downloads" section on the “Statute Regulations Program Instructions” page at left.

2013 Physician Quality Reporting System (PQRS):  2015 PQRS Payment Adjustment.  

This article provides information on the 2015 PQRS payment adjustment and guidance on how individual eligible professionals and group practices can avoid the 2015 PQRS payment adjustment. Information provided in this article is based on the 2013 Medicare PFS Final Rule.  To view click on the document titled "2013 Physician Quality Reporting System (PQRS):  2015 PQRS Payment Adjustment" in the "Downloads" section below.

Tips for Using the Quality Reporting Communication Support Page

A document titled "Tips for Using the Quality Reporting Communication Support Page" has been posted below in the "Downloads" section.  This document provides tips for entering an eRx Hardship Exemption Request to avoid the 2014 eRx Payment Adjustment, a PQRS/eRx Feedback Report Request, a PQRS Informal Review Request and a Self-Nomination Request.  Please note self-nomination only applies to certain entities, including Maintenance of Certification Boards, Registries, EHR vendors and group practices wishing to participating in the Group Practice Reporting Option (GPRO).

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