Beginning in 2015, the Centers for Medicare & Medicaid Services (CMS) will apply a -1.5 percent Physician Quality Reporting System (PQRS) payment adjustment to eligible professionals (EPs) who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule services furnished to Medicare Part B fee-for-service beneficiaries. (This includes Railroad Retirement Board and
Medicare Secondary Payer).
The PQRS payment adjustment for 2016 and subsequent years will be -2.0 percent. In 2015, large group practices with 100 or more physicians who bill under a single tax identification number may also be subject to an additional -1.0 percent payment adjustment referred to as a value modifier. Individual EPs and group practices that want to avoid a penalty in 2015 must register and select their PQRS reporting mechanism for the 2013 PQRS program year in the Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System by Oct. 15.
Who must register in the PV-PQRS Registration System by Oct. 15, 2013?
According to CMS, the following EPs must report in the PV-PQRS registration system:
- Individual physicians who want to select the CMS-calculated administrative claims reporting mechanism in calendar year (CY) 2013 in order to avoid the PQRS negative payment adjustment in 2015.
- Group practices of all sizes (2+ EPs) that want to select the registry reporting mechanism.
- Group practices of all sizes (2+ EPs) that want to select the CMS-calculated administrative claims reporting mechanism as a group in 2013.
- Avoid the PQRS negative payment adjustment in CY 2015.
- Avoid the -1.0 percent value modifier payment adjustment in CY 2015, if the group practice has 100 or more physicians and they participate in the PQRS as individuals.
- Group practices with 25 or more physicians who want to select the Group Practice Reporting option.
- Group practices with 100 or more physicians.
- Avoid the -1.0% value modifier payment adjustment in CY 2015,
- Elect quality-tiering to calculate the value-based payment modifier in CY 2015.
Note: Per CMS, individual reporting of PQRS measures does not meet the requirement for group participation in PQRS (even if every member of the group participates). If individuals choose to participate in PQRS at the individual level in order to earn a payment incentive, the group, as a whole, must still/also sign up in 2013 for one of the three PQRS group reporting options that will allow the group to avoid a -1 percent payment adjustment under the value modifier in 2015.
Who does not need to register in the PV-PQRS Registration System?
Individual EPs who will participate in the 2013 PQRS program year via claims, a participating registry, or participating/qualified EHR:
- Claims — For claims-based reporting, all claims adjustments, re-openings, or
appeals must reach the national Medicare claims system data warehouse by Feb.
28, 2014, to be included in the 2013 PQRS analysis.
- Participating registry — TMA endorses two registries for PQRS: PQRSwizard and Covisint PQRS. The submission deadline for the PQRSwizard registry is March 13,
2014. For the Covisint PQRS registry, the submission deadline is March 1, 2014. Learn about TMA's discounted rates for these registries.
- Electronic health records (EHRs) - The submission deadline to report quality data through the EHR-based reporting method is Feb. 28, 2014.
How to Register or Modify an Existing Registration
For assistance, you may contact the CMS Quality Net Help Desk at (866) 288-8912 (TTY:  715-6222) Monday through Friday,7 am-7 pm CT, or by email at email@example.com.
Learn more about PQRS. If you have questions, call the TMA Knowledge Center at (800) 880-7955.
Action, Oct. 1, 2013