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2012 Physician Quality Reporting System 2012 Physician Quality Reporting System Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures The following documents pertaining to the 2012 Physician Quality Reporting System Measure- Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures are available in the zip file titled "2012 Physician Quality Reporting System Measure Applicability Validation Documents" in the "Downloads" section below: • 2012 Physician Quality Reporting System Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures - provides guidance for those eligible professionals who satisfactorily submit quality data codes for fewer than three Physician Quality Reporting measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures • 2012 Physician Quality Reporting Measure-Applicability Validation Process Release Notes - the release notes for the changes occurring for the 2012 Physician Quality Reporting Measure- Applicability Validation (MAV) Process • 2012 Physician Quality Reporting System Measure-Applicability Validation Process Flow - a chart that depicts the Measure Applicability Validation (MAV) Process Incentive Payments Eligible professionals who satisfactorily report quality-measures data for services furnished during a Physician Quality Reporting System reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period. Below are the authorized incentive payment amounts for each program year: • 2007 Physician Quality Reporting System – 1.5% subject to a cap;
• 2008 Physician Quality Reporting System – 1.5%;
• 2009 Physician Quality Reporting System – 2.0%; and
• 2010 Physician Quality Reporting System – 2.0%. The Affordable Care Act authorized incentive payment through 2014; • 2011 Physician Quality Reporting System-1%
• 2012 Physician Quality Reporting System-0.5%
• 2013 Physician Quality Reporting System-0.5%
• 2014 Physician Quality Reporting System-0.5% Incentive payments for each program year are issued separately as a single consolidated incentive payment in the following year. Incentive payments are issued to the first valid group location listed under the Taxpayer Identification Number (TIN); or, for solo practitioners, to the first valid practice location listed under the TIN. The Carrier or A/B MAC will make the payment electronically or via check, based on how the TIN normally receives payment for Medicare Part B PFS covered professional services furnished to Medicare beneficiaries. If a TIN submits claims to multiple Medicare claims-processing contractors (Carriers or A/B MACs), each contractor may be responsible for a proportion of the TIN incentive payment equivalent to the proportion of Medicare Part B PFS claims the contractor processed during the applicable reporting period. (Note: If splitting an incentive across contractors would result in any contractor issuing a Physician Quality Reporting System incentive payment less than $20 to the TIN, the incentive will be issued by fewer contractors than may have processed PFS from the TIN for the reporting period). The Physician Quality Reporting System incentive payment can be offset by an outstanding debt for the TIN. The incentive payment, with the remittance advice, will be issued by Carrier or A/B MAC and identified as a lump-sum Physician Quality Reporting System incentive payment. The electronic remittance advice sends only a 2-character code ("LS" – lump sum). This code will appear in PLB03-1 on the outgoing 835. The paper remittance advice states, "This is a Physician Quality Reporting System incentive payment." CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or eRx incentive), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2010 PQRI incentive payments, the 4-digit code is PQ10. This code will be displayed on the electronic remittance advice along with the LE indicator. For example, eligible professionals will see the LE to indicate an incentive payment, along with PQ10 to identify that payment as the 2010 PQRI incentive payment. Additionally, the paper remittance advice will read, "This is an PQRS incentive payment." The year will not be included in the paper remittance. Once we begin distributing incentive payments for a particular program year and your lump-sum incentive does not arrive or the incentive payment amount does not match what is reflected in your Physician Quality Reporting System feedback report, contact your Carrier or A/B MAC (click on the "Help Desk Support" link at left for contact information). Note: The incentive amount may differ by a penny or two from what is reflected in your feedback report due to rounding. 2011 Physician Quality Reporting System 1st Quarter 2011 Physician Quality Reporting System QDC Submission Error Report by Speciality This report, which is available in the "Download" section below includes claims data for services provided from January 1, 2011 through March 25, 2011 and processed by March 25, 2011. 1st Quarter 2011 Physician Quality Reporting System QDC Submission Error Report by Measure This report, which is available in the "Download" section below includes claims data for services provided from January 1, 2011 through March 25, 2011 and processed by March 25, 2011. 2nd Quarter 2011 Physician Quality Reporting System QDC Error Report by Speciality This Report is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through June 30, 2011 and processed by June 24, 2011 2nd Quarter 2011 Physician Quality Reporting System QDC Error Report by Measure This Report is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through June 30, 2011 and processed by June 24, 2011 For information on how the 2011 Physician Quality Reporting System measure-applicability validation will be implemented, see the document titled "2011 PQRI Measure-Applicability Validation Process for Claims-Based Reporting of Individual Measures" which is available in the "Downloads" section below. Physician Quality Reporting System Feedback Reports Each year, the Physician Quality Reporting System incentive payment and the Physician Quality Reporting System feedback report are issued through separate processes (click on the appropriate "Physician Quality Reporting System" link at left for information specific to a particular program year). Physician Quality Reporting System feedback report availability is not based on whether or not an incentive payment was earned. Feedback reports will be available for every TIN under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported at least one valid Physician Quality Reporting System measure a minimum of once during the reporting period. To view a sample feedback report, see the document titled "Feedback Report Examples", which is available in the "Downloads" section below. Physician Quality Reporting System participants will not receive claim-level details in the feedback reports. All previously program year documents have been moved and are now available on that specific program year section page at left.
Page Last Modified: 11/15/2011 12:02:25 PM
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