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Physician Quality Reporting System formerly known as the Physician Quality Reporting Initiative Click on the "Spotlight" link to the left to view "What's New" (recently posted items) Background. The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-275) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). In 2011, the program name was changed to Physician Quality Reporting System (Physician Quality Reporting). For each program year, CMS implements Physician Quality Reporting through an annual rulemaking process 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. The Medicare Improvements for Patients and Providers Act (MIPPA) requires the Secretary to post on the CMS Web site, in an easily understandable format, a list of the names of eligible professionals (or group practices) who satisfactorily submitted data on quality measures for the Physician Quality Reporting System and the names of the eligible professionals (or group practices) who are successful electronic prescribers. A "List of Eligible Professionals" who may participate in Physician Quality Reporting is available in the "Downloads" section below. 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. 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. 2011 Physician Quality Reporting. To participate in the 2011 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. 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 2011 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal to 1.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period. A group practice may also potentially qualify to earn Physician Quality Reporting incentive payment equal to 1.0% of the group practice’s total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2011 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 options, as a new option for 2011 (GPRO II) has been established. This section will also provide instructions on how a group practice can sign up to participate in either GPRO I or GPRO II. Maintenance of Certification Program Incentive. Beginning in 2011, physicians will have the opportunity to earn an additional incentive of 0.5% by working with a Maintenance of Certification entity and by completing the following: • Satisfactorily submitting data, without regard to method, on quality measures under Physician Quality Reporting, for a 12-month reporting period either as an individual physician or as a member of a selected group practice. AND • More frequently than is required to qualify for or maintain board certification: o Participate in a Maintenance of Certification Program and
o Successfully complete a qualified Maintenance of Certification Program practice assessment. Please see the "Maintenance of Certification Program Reporting Requirements" which includes all criteria for incentive eligibility under the "Downloads" section below. Note: CMS has received inquiries from potential Maintenance of Certification entities requesting clarification on the "more frequently" requirement for participation. CMS has issued the "Physician Quality Reporting System Maintenance of Certification Program Incentive Guidance" to clarify participation requirements, which is located under the "Downloads" section below. Letter to Medicare Beneficiaries. CMS has posted a letter to Medicare beneficiaries with important information about the PQRI. The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy to their patients in support of their PQRI participation. To obtain a copy of the letter, see the "Related Links Inside CMS" section below.
Page Last Modified: 10/17/2011 1:52:05 PM
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