Physician Quality Reporting System
The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time. Click here for a brief introductory video that explains how PQRS can help improve health care and to whom the system applies.
By reporting on PQRS quality measures, individual EPs and group practices can also quantify how often they are meeting a particular quality metric. In 2015, the program began applying a negative payment adjustment to individual EPs and PQRS group practices who did not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule (PFS) covered professional services in 2013.
Those who report satisfactorily for the 2016 program year will avoid the 2018 PQRS negative payment adjustment.
PQRS Quick Links
For step-by step instructions on how to implement PQRS, view the How to Get Started webpage. In addition, learn more about PQRS and how to participate by visiting the following webpages:
- For information on quality measures including specification and selection, visit the Measures Codes webpage.
- For information on 2016 reporting mechanisms, review the following pages:
- Registry Reporting webpage
- Electronic Reporting Using an Electronic Health Record (EHR) webpage
- Qualified Clinical Data Registry (QCDR) webpage
- Group Practice Reporting Option (GPRO) Web Interface webpage
- CMS-Certified Survey Vendor page. Note: CAHPS for PQRS information is included on this webpage.
- For information on payments, visit the Analysis and Payment webpage. Note that incentive payments were only authorized through 2014 program year reporting.
- For information on negative payment adjustments, review the Payment Adjustment Information webpage
If you have questions or need assistance with PQRS reporting, contact the QualityNet Help Desk. The Help Desk is available Monday – Friday; 7:00 AM – 7:00 PM Central Time (CT):
Phone: 1-866-288-8912 TTY: 1-877-715-6222 Email: Qnetsupport@hcqis.org
Sign-Up and Registration Information
While individual EPs do not need to sign up or pre-register in order to participate in PQRS, group practices wishing to participate via the GPRO must register. To avoid the PQRS negative payment adjustment, an EP or PQRS group practice must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period. Please review the "2016 List of Eligible Professionals" on the PQRS How to Get Started webpage to confirm eligibility to participate in PQRS.
Note: The PQRS program requirements and measure specifications for the current program year may be different from the PQRS program requirements and measure specifications from a prior year. Individual EPs and PQRS group practices are responsible for ensuring that they are using the PQRS documents for the correct program year.
Individual EPs may choose to report information on individual PQRS quality measures or measures groups using a variety of mechanisms. Please see the PQRS How to Get Started webpage for a list of resources and where to find additional information.
Disclaimer: If a group is reporting for PQRS through another Centers for Medicare & Medicaid Services (CMS) program (such as the Comprehensive Primary Care Initiative, Medicare Shared Savings Program, or Pioneer Accountable Care Organizations), please check the program’s requirements for information on how to report quality data to avoid the PQRS payment adjustment. Please note: Although CMS has attempted to align or adopt similar reporting requirements across programs, EPs should look to the respective quality program to ensure they satisfy the requirements for each program (such as PQRS, EHR Incentive Program, Value-based Payment Modifier (Value Modifier), etc.) in which they participate.
- Page last Modified: 10/11/2016 1:46 PM
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