Didn't Report PQRS in 2013? You Can Still Avoid Penalty

Eligible physicians (EPs) not participating in the Physician Quality Reporting System (PQRS) for the 2013 reporting year will pay a 1.5-percent penalty on their Medicare claims in 2015. However, individual physicians and group practices that have not yet reported PQRS data, did not elect the administrative claims-based reporting option in October, and do not plan on meeting the full requirements to earn the 0.5 percent bonus still can avoid the penalty.

According to the Centers for Medicare & Medicaid Services (CMS), the following options are available.

Individual EPs

EPs can avoid the penalty if they report at least: 

  • One valid individual measure via claims, participating registry, or qualified electronic health record (EHR); or
  • One valid measure in a measures group via claims or participating registry. 

Group Practices 

Group practices participating in the group practice reporting option, referred to as GPRO, can avoid the penalty if they report at least: 

Note: You will not earn the 2013 PQRS 0.5-percent bonus payment simply by reporting one valid measure or one measures group. You will only avoid the future 1.5-percent penalty in 2015. Physicians and group practices can still participate fully in PQRS for 2013 — thus earning the bonus and avoiding the penalty — by reporting the required measures via claims, registry, or qualified EHR.

PQRS Reporting Methods and Deadlines

Claims-Based Reporting: All claims adjustments, re-openings, or appeals processed by Novitas Solutions must reach the national Medicare claims system data warehouse by Feb. 28, 2014, to be included in the 2013 PQRS analysis. To view a claims example, see CMS-1500 Claim PQRS Example.

Participating Registry: TMA endorses two registries for PQRS: PQRSwizard and Covisint PQRS. The submission deadline for the PQRSwizard registry is March 13, 2014. For Covisint PQRS, the submission deadline is March 1, 2014. Learn about TMA's discounted rates for these registries. 

Electronic Health Record (EHR): You have until Feb. 28, 2014, to submit data via a qualified EHR. Find out from your EHR vendor if this capability is incorporated into your EHR or is an add-on service.

More Information  


Action, Jan. 17, 2014


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