• The CMS Physician Quality Reporting System (PQRS) program

    • TMA Offers Member Discounts for PQRS Reporting

      Participation in the Physician Quality Reporting System, formerly known as PQRI, does not have to be complicated or require complex coding systems and expensive manual processes. TMA endorses two qualified registries or online tools for PQRS: PQRSwizard, and Covisint PQRS. Each provides a simple and cost-effective way for eligible physicians to collect and report quality measures data under the PQRS pay-for-reporting program. 

      PQRSwizard and Covisint PQRS will each guide you through four easy steps: (1) select your measures, (2) register, (3) enter clinical data for 20 patients for measures group reporting (11 of which must be Medicare Part B patients) or 50 percent of eligible instances of your Medicare Part B patients for individual measures reporting, and (4) review and submit using the online application. Eligible physicians can earn an additional 0.5 percent of total estimated Medicare Part B allowed charges for the reporting year. 

      PQRSwizard and Covisint PQRS are easy to use and competitively priced with TMAs discounted rate: $199 for PQRSwizard, and $195 for Covisint PQRS (use discount code TMAPQRS14). The tools enable you to participate in the PQRS program without modifying your billing processes. 

      TMA members also receive exclusive pricing for the on-demand webinar 2014 Physician Quality Reporting System (PQRS), now available in the TMA Education Center.

      Find more on PQRS from the Centers for Medicare & Medicaid Services (CMS).

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  • What is the CMS Physician Quality Reporting System (PQRS) program?

    • CMS launched the Physician Quality Reporting Initiative Program (now PQRS) in 2007.

        

      PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality data by physicians and other eligible health care professionals that provide care to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). The program's intent is to get physicians used to documenting and reporting the care they already provide to patients.

      Incentive Payment

      In 2007 and 2008, the bonus equaled 1.5 percent of a physician's total allowed charges for Physician Fee Schedule services. That increased to 2 percent in 2009 and 2010. Under the Affordable Care Act, however, the bonuses dropped to 1 percent for 2011 and 0.5 percent for 2012 through 2014.

      Payment Adjustment

      Physicians who do not report quality data to CMS for the 2014 PQRS program year will see a negative 2-percent payment adjustment in 2016. Click here to learn more about the PQRS payment adjustment.

  • What is the CMS Value-Based Payment Modifier program?

    • The goal of CMS is to move toward physician payment based on value rather than volume.

       

      Beginning in 2015, physicians deemed eligible professionals (EPs) who did not report or satisfactorily participate in PQRS in 2013 will be paid 1.5 percent less than the Medicare Physician Fee Schedule (MPFS) amount for services. Physicians in group practices with 100 or more EPs will be subject to an additional 1 percent pay cut under the value modifier program in 2015, based on their quality and cost performance in 2013. The value modifier is based on participation in PQRS. These payment adjustments will apply to all Part B covered professional services under the MPFS.   

      Physicians can avoid the payment adjustments in 2016 by reporting PQRS data in 2014. Failure to report in 2014 will result in a 2-percent payment adjustment in 2016 under PQRS for all physicians, plus another 2 percent payment adjustment under the value modifier for group practices with 10 or more EPs. Refer to this graph to see how PQRS participation affects the value modifier.

      ALL physicians who participate in fee-for-service Medicare will be subject to the value modifier in 2017. 

      Click here to learn more about the value modifier.

  • Why should I participate in PQRS?

    • Physicians who participate in PQRS can find many advantages.

       

      They include:

      • Improving the quality of care they provide
      • Increasing the payment they receive for services
      • Better preparation for future changes in the health care delivery system

      Read more
  • What do I need to know about the Physician Compare website?

    • The Affordable Care Act requires CMS to make physician performance information publicly available online by Jan. 1, 2013.

        

      Based on Section 10331 of the Affordable Care Act, CMS plans to make information on physician performance public on the Physician Compare Web Site. This will include measures collected under PQRS.

      Several physicians have notified TMA that CMS has posted incomplete and/or inaccurate information on its website. We were concerned about this issue prior to implementation and made CMS aware of our concerns. “In order to ensure accuracy,” the association wrote, “TMA recommends CMS establish a process by which an individual physician or physicians in a group practice can review and update their demographic information directly through the website.” Additionally, we believe that physicians involved in the treatment of a patient must have the opportunity for review, comment, and the right to appeal any data that is part of the public review process, prior to posting such information on the site. Any such comments resulting from the review and appeal process must be included with any publicly reported data.

      Should they find any errors, TMA recommends that physicians contact the CMS QualityNet Help Desk at (866) 288-8912 to update their information.

  • How do I participate in PQRS?

    • Use the following information to find out how to participate in PQRS.

        

      The first step in getting started with PQRS is to determine eligibility. Click here to see a list of eligible professionals (EPs).

      Physicians may participate in PQRS as Individual EPs, as a group practice reporting as Individual EPs, or as a group practice under the Group Practice Reporting Option (GPRO). Group practices that plan on reporting under GPRO must self-nominate/register by September 30, 2014. Click here to learn why a group practice may want to or should register under GPRO.  

      PQRS reporting methods vary and reporting can be done via claims (CMS-1500 form), qualified registry, direct electronic health records (EHRs) using Certified EHR Technology (CEHRT), CEHRT via data submission vendor, qualified clinical data registry (QCDR), web interface, and CG CAHPS CMS-certified survey vendor. 

      PQRS Reporting Options

      TMA encourages those physicians who have adopted EHRs to check with their vendor to see if their system is capable of reporting their PQRS data to CMS. This route minimizes practice resources as it is often a free service and does not require staff time to review charts and to re-enter patient information.

      TMA recommends physicians who have not adopted EHRs to use a registry to report to CMS. Registries have undergone a CMS vetting process that includes checking their ability to provide the required PQRS data elements, ensuring that the registry calculates the measure's reporting and performance rates correctly, and transmitting the required information in the requested file format. Read more about the benefits of registry reporting in the November 2014 issue of Texas Medicine.

      Reporting via registry has proven to be more successful than via claims.  However, if physicians prefer to report via claims, the American Medical Association has a participation tool on its website to help physicians successfully report on individual measures via the claims-based reporting method. Click here to learn more about AMA’s participation tool.

      Click here for more information on how to get started with PQRS.

  • How do I select which PQRS measures I will report on?

    • According to CMS, the 2014 PQRS measures address different aspects of care, such as prevention, chronic- and acute-care management, procedure-related care, resource utilization, and care coordination.

       

      When selecting measures, eligible professionals (EP) should begin with a review of the 2014 Physician Quality Reporting System (PQRS) Measures List to determine which measures, associated domains, and reporting option(s) are applicable to the EP or group practice for the 2014 PQRS program year. 

      Before selecting measures, EPs should consider the following factors:
      • Clinical conditions usually treated
      • Types of care typically provided
      • Settings where care is usually delivered
      • Quality improvement goals for 2014
      • Other quality reporting programs in use or being considered

      In 2014, most PQRS reporting options require an EP or group practice to report 9 or more measures covering at least 3 National Quality Strategy (NQS) domains for incentive purposes. The domains associated with the measures are as follows:
      • Patient Safety
      • Person and Caregiver-Centered Experience and Outcomes
      • Communication and Care Coordination
      • Effective Clinical Care
      • Community/Population Health
      • Efficiency and Cost Reduction

      All practices and their patient mixes are different, and TMA recommends physicians contact their specialty medical society for the most relevant individual measures and/or measure groups on which they can report.

      Click here to learn more about PQRS measures. 

       

  • What do I need to know about Maintenance of Certification (MOC)?

    • Physicians have the opportunity to earn a 0.5 percent PQRS incentive and an additional incentive of 0.5 percent when they also meet the requirements for the MOC program.

        

      Contact your medical specialty society to see if you are eligible for this year's PQRS MOC bonus.

      Click here to learn more about the PQRS MOC Program Incentive. 

  • When are the PQRS deadlines?

  • How do I get my PQRS Feedback Report and Quality and Resource Use Report?

    • Practices may call CMS directly for help or find their own information online.

      PQRS Feedback Reports
      For information on PQRS feedback reports and step-by-step guidance on how to request one, click here.
      For technical assistance, contact the CMS QualityNet Help Desk:
      Monday - Friday: 7 am - 7 pm, CT
      Phone: (866) 288-8912 (TTY 1-877-715-6222)
      Email: Qnetsupport@hcqis.org


      Quality and Resource Use Reports (QRURs)
      The Value-Based Payment Modifier is based on PQRS data and cost performance. For information on QRURs and step-by-step guidance on how to request one, click here.  For questions related to an IACS account and accessing your QRUR, contact the CMS Quality Net Help Desk.
      For technical assistance about information in your QRUR, contact the CMS Physician Value Help Desk:
      Monday – Friday: 7 am – 7 pm, CT
      Phone: (888) 734-6433, press option 3; (TTY 1-888-734-6563)
        

  • What other resources for PQRS should I be aware of?

  • Get the latest news on PQRS.

  • Whom do I contact if I have more questions?