Analysis and Payment
Each year, Physician Quality Reporting System (PQRS) individual eligible professionals (EPs) and PQRS group practices receive feedback reports on whether they satisfactorily reported and if they are subject to the future negative payment adjustment. Note that program participation during a calendar year will affect payments after two years (i.e., 2016 program participation affects 2018 payments). Incentive payments for PQRS were only authorized through program year 2014; feedback reports for program years 2007-2014 indicated incentive eligibility.
Enterprise Identity Management System (EIDM)
PQRS participants and their staff will need an Enterprise Identity Management System (EIDM) account. EIDM is accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at https://portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications, including feedback reports.
- EIDM User Guides and Resources
- The EIDM System Toolkit packages helpful resources for users, including those who transitioned from IACS to EIDM
- EIDM Quick Reference Guides are available on the Physician and Other Health Care Professionals Quality Reporting Portal.
- For additional assistance regarding EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at firstname.lastname@example.org.
Feedback reports will be available for every Taxpayer Identification Number (TIN) under which at least one individual EP (identified by his or her National Provider Identifier, or NPI) or PQRS group practice submitting Medicare Part B Physician Fee Schedule (MPFS) claims reported at least one valid PQRS measure a minimum of once during the reporting period. PQRS participants will not receive claim-level details in the feedback reports. For information on 2015 feedback reports (available in late 2016) and how to request them, visit the How to Obtain a Quality Resource and Usage Report (QRUR) webpage. Feedback reports for program year 2016 will be available in late 2017.
Individual EPs, designated support staff/vendors, and group practices that believe they have been incorrectly assessed the 2017 PQRS negative payment adjustment may request to have an informal review of their PQRS reporting performance. To request an informal review, visit the Physician and Other Health Care Professionals Quality Reporting Portal, then select “Communication Support Page” under “Related Links” in the upper left navigation pane. In the drop down menu, select “Informal Review Request” and choose the appropriate option.
An informal review may be requested if the feedback report reveals that the individual EP or PQRS group practice disagrees with the analysis of satisfactory reporting to avoid a future payment adjustment. Informal review requests for 2015 reporting may be submitted in the fall of 2016. See the 2015 PQRS: 2017 PQRS Negative Payment Adjustment - Informal Review Made Simple. Please note that the informal review decision will be final, and there will be no further review. Update: On 11/30/2016, CMS extended the deadline to 12/7/2016.
2016 PQRS Measure-Applicability Validation (MAV) Process for Claims and Registry-Based Reporting of Individual Measures
The following document pertaining to the 2016 PQRS Measure-Applicability Validation (MAV) process for claims-based reporting of individual measures is available:
- 2016 PQRS Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures – provides guidance for individual EPs who satisfactorily submit quality-data codes for fewer than 9 PQRS measures or for fewer than 3 National Quality Strategy (NQS) domains, and describes how the MAV process will determine whether they should have submitted quality data codes (QDCs) for additional measures. This also includes the process flow depicting the MAV process.
The following document pertaining to the 2016 PQRS Measure-Applicability Validation (MAV) process for registry-based reporting of individual measures is available:
- 2016 PQRS Measure-Applicability Validation (MAV) Process for Registry-Based Reporting of Individual Measures – provides guidance for those individual EPs or group practices who satisfactorily submit measures via a qualified registry for fewer than 9 PQRS measures or for fewer than 3 NQS domains, and how the MAV process will determine whether they should have submitted additional measures. This also includes the process flow depicting the MAV process.
Measure-Applicability Validation (MAV) Web-based Training Course and YouTube Video
The 2016 Measure-Applicability Validation (MAV) Web-based, self-paced training course is designed for individual EPs reporting measures via claims or an individual EP or group practice reporting via a registry vendor. The course presents a high-level overview of the MAV process and how it will apply for 2016 PQRS reporting purposes.
The course includes the following four modules:
Module 1: MAV Overview
Module 2: Knowing When MAV Applies
Module 3: MAV Analysis Process
Module 4: MAV Scenarios
The course also provides real-world MAV scenarios, in addition to providing helpful information on how to avoid the 2018 PQRS payment adjustment. A certificate of completion is available at the end of the course.
The following documents have been added to assist individual EPs and PQRS group practices with accessing and interpreting 2015 PQRS feedback reports.
- Quick Reference Guide for Accessing 2015 PQRS Feedback Reports- This Quick Reference Guide (QRG) illustrates how to access and generate the 2015 PQRS Feedback Reports.
- 2015 PQRS Feedback Report User Guide- This User Guide assists individual EPs and PQRS group practices with understanding and interpreting the 2015 PQRS feedback reports.
2015 PQRS: Resources for the 2015 PQRS Feedback Reports – This document provides helpful resources for 2015 PQRS participants who would like to access and understand their PQRS feedback reports and determine whether or not the 2017 PQRS downward payment adjustment will be applied.
2014 PQRS Reporting Experience, Including Trends (2007-2015)
The following "2014 PQRS Reporting Experience, Including Trends (2007-2015)" documents are available:
- 2014 PQRS Reporting Experience, Including Trends (2007-2015) - summarizes the historical reporting experience of eligible professionals and group practices in the PQRS through program year 2014 as well as preliminary PQRS data for the 2015 program year.
- 2014 PQRS Release Appendix - provides tables and explains data and methods for the report.
Negative Payment Adjustments Authorized Through 2018
Individual EPs who satisfactorily reported quality-measures data for services furnished during a PQRS reporting period avoid a future payment adjustment. The negative payment adjustment is equal to a percentage of the individual EP’s or PQRS group practice's estimated total allowed charges for covered MPFS services provided during the payment adjustment period.
- 2013 PQRS - negative 1.5% of MPFS in 2015
- 2014 PQRS - negative 2.0% of MPFS in 2016
- 2015 PQRS - negative 2.0% of MPFS in 2017
- 2016 PQRS - negative 2.0% of MPFS in 2018
- Page last Modified: 12/21/2016 5:03 PM
- Help with File Formats and Plug-Ins