Physician Quality Reporting System
Physician Quality Reporting System formerly known as the Physician Quality Reporting Initiative
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Background. The Physician Quality Reporting System (Physician Quality Reporting or PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Beginning in 2015, the program also applies a payment adjustment to eligible professionals who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for the Physician Quality Reporting.
The Physician Quality Reporting is mandated by federal legislation. CMS implements Physician Quality Reporting through regulations published in the Federal Register. Information regarding the relevant statutes and regulations can be viewed by clicking on the "Statutes/Regulations/Program Instructions" link at left.
No Sign Up or Pre-Registration.
Individual eligible professionals do not need to sign-up or pre-register in order to participate in the Physician Quality Reporting. However, to qualify for a Physician Quality Reporting incentive payment an eligible professional must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period. A revised "List of Eligible Professionals" who may participate in Physician Quality Reporting is available in the "Downloads" section below.
Note: The Physician Quality Reporting program requirements and measure specifications for the current program year may be different from the Physician Quality Reporting program requirements and measure specifications for a prior year. Eligible professionals are responsible for ensuring that they are using the Physician Quality Reporting documents for the correct program year.
2013 Physician Quality Reporting
To participate in the 2013 Physician Quality Reporting, individual eligible professionals may choose to report information on individual Physician Quality Reporting quality measures or measures groups: (1) to CMS on their Medicare Part B claims, (2) to a qualified Physician Quality Reporting registry, or (3) to CMS via a qualified electronic health record (EHR) product, or 4) to a qualified Physician Quality Reporting data submission vendor. Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2013 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period. To learn more about how to participate in the Physician Quality Reporting, visit the "How To Get Started" link as well as the "Educational Resources" link at left. Fact sheets are available to help you understand the requirements associated with each reporting option. Information specific to reporting via a registry, EHR direct or EHR data submission vendor can be found at the respective "Registry Reporting" and "Electronic Health Record Reporting" links to the left.
A group practice may also potentially qualify to earn Physician Quality Reporting incentive payments equal to 0.5% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2013 Physician Quality Reporting System reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS. Click on the "Group Practice Reporting Option" link at left to learn more about this reporting option.
To find out who to contact with questions regarding the Physician Quality Reporting, click on the "Help Desk Support" link at left.
2011 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program Experience Report
This report summarizes the reporting experience of eligible professionals in these programs in 2011, historical trends, and preliminary results for the 2012 program year. Each year growth in participation across all reporting options has increased. Overall, 280,229 eligible professionals participated individually in the 2011 PQRS. A total of $261,733,236 in PQRS incentive payments was paid by CMS for the 2011 program year. In addition, 282,382 eligible professionals participated in the 2011 eRx Incentive Program, which was a 116 percent increase from total participants in 2010. A total of $285,049,103 in eRx incentive payments was paid for the 2011 program year. In addition, 135,931 eligible professionals were subject to the 2012 eRx payment adjustment because they either did not qualify for an exemption, meet exclusion criteria for the adjustment, or did not meet eRx reporting requirements in the first half of 2011.
- Page last Modified: 05/13/2013 8:49 PM
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