Skip to Main Content

Spotlight

Quick-Reference Guide for Understanding the 2015 PQRS Negative Payment Adjustment (10-15-2014)

This document describes how the 2015 PQRS negative payment adjustment was 1) assessed and 2) applied for individual eligible professionals (EPs) and group practices participating in the PQRS group practice reporting option (GPRO). To view this document visit the Analysis and Payment section page.

2013 PQRS: Incentive Eligibility and New 2015 Negative Payment Adjustment – Informal Review Made Simple (10-15-2014)

This fact sheet provides information about the 2015 PQRS negative payment adjustment as well as step-by-step guidance for requesting an informal review during the official time period of January 1, 2015 through February 28, 2015, for the 2013 PQRS program year. To view this document visit the Analysis and Payment section page.

New! CMS is Accepting Suggestions for Potential Physician Quality Reporting System Measures and/or Measures Groups (10-03-2014)

The Centers for Medicare & Medicaid Services (CMS) is accepting quality measure suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System for future rule-making years. Quality measures submitted in this Call for Measures may also be considered for use in other quality programs for physicians and other eligible professionals (e.g. Value Based Modifier, Physician Compare, Medicare Shared Savings Program, etc.).

The PQRS Call for Measures is now conducted in an ongoing open format, remaining open indefinitely. The month that a measure is submitted for consideration will determine when it may be included on the Measures Under Consideration (MUC) list. Measures submitted prior to June 15, 2015 may be considered for inclusion on the 2015 MUC list for implementation in PQRS as early as 2017.

Each measure submitted for consideration must include all required supporting documentation. Measure submissions that name a measure steward other than the organization submitting the potential measure must include documentation that the measure steward has agreed to maintain the measure if it is accepted. Submissions missing documentation of the steward's commitment to maintain a proposed measure will be automatically eliminated from the measure review process.

Documentation requirements and the schedule of cut-off dates for the yearly MUC list inclusion are posted on the Measures Management System Call for Measures Web page. Only those measures submitted in the provided format will be accepted for consideration. Questions about this Call for Measures or the required documentation may be submitted to C4M@wvmi.org.

When submitting measures for consideration, please ensure that your submission is not duplicative of another existing or proposed measure. Submitted measures must be further along in development than a measure concept. Additionally, CMS is not accepting claims-based only reporting measures in this process. Note that measures already included in previous PQRS MUC lists may only be re-submitted for consideration if the measure has undergone substantive changes.

CMS is seeking a quality set of measures that are outcome-based rather than clinical process measures. Other measure types that CMS is interested in include measures of patient safety and adverse events, appropriate use of diagnostics and therapeutics, care coordination and communication, patient experience and patient-reported outcomes and measures of cost and resource use. Additionally, CMS is seeking measures that have incorporated consumer input into the development and maintenance of the suggested measures.

Measures submitted for consideration will be assessed to ensure that they meet the needs of the Physician Quality Reporting System. As time permits, feedback will be provided to measure submitters upon review of their submission.

Note: Suggesting individual measures or measures for a new or existing measures group does not guarantee the measure(s) will be included in the proposed or final sets of measures of any Proposed or Final Rules that address the Physician Quality Reporting System. Additionally, measures submitted for consideration are not guaranteed to be put forth on the MUC list. CMS will determine which individual measures and measures group(s) to include in the proposed set of quality measures, and after a period of public comment, the agency will make the final determination with regard to the final set of quality measures for the Physician Quality Reporting System.

Related Links

  • _