How To Get Started
Find out whether you are eligible to participate in 2016 PQRS to avoid the 2018 negative payment adjustment. View our 2016 PQRS List of Eligible Professionals to determine your eligibility.
2016 PQRS Implementation Guide
The 2016 PQRS Implementation Guide helps individual EPs and PQRS group practices of all awareness levels understand PQRS. It includes PQRS information related to the program itself, measures and analysis, and where to go to learn more about each PQRS reporting mechanism.
- Learn how to report with the “Quality Reporting Roadmap.”
- Learn how your data is utilized with the “Take a Moment & Participate Flowchart.”
Step-by-Step Instruction in Getting Started with the Physician Quality Reporting System (PQRS)
Note: For eligible professionals participating in other Medicare quality programs (electronic reporting using an EHR, Value-based Modifier, and Accountable Care Organizations), please see How to Report Once for 2015 Medicare Quality Reporting Programs.
STEP 1: Determine your eligibility
Find out whether you are eligible to participate in 2015 PQRS to avoid the 2017 negative payment adjustment. View our 2015 PQRS List of Eligible Professionals to determine your eligibility.
STEP 2: Determine whether you want to participate in PQRS as an individual eligible professional (EP) or as part of a group practice
- Individual EPs are identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN).
- A group practice under 2015 PQRS is defined as a single Tax Identification Number (TIN) with 2 or more individual EPs who have reassigned their billing rights to the TIN. Group practices can register to participate in PQRS via the group practice reporting option (GPRO) to be analyzed at the group (TIN) level. Note that group practices participating via GPRO are referred to as PQRS group practices.
STEP 3: Choose your reporting mechanism
Depending on whether you are participating in PQRS as an individual EP or as part of a PQRS group practice, you have several reporting mechanisms by which you can choose to submit your PQRS data.
Individual EPs may choose to report information on individual PQRS quality measures or measures groups using the following mechanisms:
(1) Medicare Part B claims
Group Practices may choose to report information on PQRS quality measures using the following mechanisms:
(1) Qualified PQRS registry
STEP 4: Choose which quality measures to report
Individual EPs and PQRS group practices should choose at least 9 individual measures across 3 National Quality Strategy (NQS) domains or 1 measures group as an option to report on measures to CMS (with the exception of GPRO Web Interface). Individual EPs or PQRS group practices are also required to report one (1) cross-cutting measure if they have at least one (1) Medicare patient with a face-to-face encounter. Review the following supporting documentation for specific criteria to satisfactorily report on these two options.
Note: For PQRS group practices electing to report via the GPRO Web Interface, CMS will pre-populate the Web Interface with a sample patient population for all 17 of the GPRO Web Interface measures.
The following documents can be found on the Measures Codes section page or by clicking on the following: 2015 PQRS Individual Claims Registry Measure Specification Supporting Documents zip file and the 2015 PQRS Measure List Implementation Guide zip file.
STEP 5: Review PQRS Payment Adjustment information
Individual EPs and group practices who do not satisfactorily report data on quality measures for covered professional services will be subject to a negative payment adjustment under PQRS beginning in 2015. The PQRS negative payment adjustment applies to all of the EP’s or group practice’s Part B covered professional services under the Medicare Physician Fee Schedule (MPFS). Review information on the PQRS Payment Adjustment page for complete information on how to avoid future PQRS payment adjustments.
STEP 6: Review the PQRS Timeline
Plan ahead! View the 2015-2017 PQRS Timeline to keep track of PQRS-related milestone dates and corresponding resources.
Contact the QualityNet Help Desk for help with:
- General CMS PQRS information
- Portal password issues
- PQRS/eRx feedback report availability and access
- PQRS-IACS registration questions and login issues
Monday – Friday; 7:00 a.m.–7:00 p.m. Central Time (CT)
Frequently Asked Questions (FAQs)
Visit our Physician Quality Reporting System FAQ page and enter keywords in the search box to find answers on "How do I get started" or any other area of the program on which you may have questions.
To view the 2015 PQRS program requirements, review the 2015 Medicare Physician Fee Schedule Final Rule.
Stay informed about the latest PQRS news by subscribing to the PQRS Listserv.
- Page last Modified: 04/01/2016 5:25 PM
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