• 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.

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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.

       

      To help improve the quality and efficiency of medical care, the value-based payment modifier program will provide physicians performance data so they can assess and improve the care they deliver.

      Physicians in group practices with 10 or more eligible professionals who submit claims to Medicare under a single taxpayer identification number will be subject to the value modifier in 2016, based on their performance in the 2014 PQRS program year. Failing to report quality data to CMS will result in a negative 2-percent value modifier adjustment in addition to the negative 2-percent PQRS payment adjustment. 

      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. 

      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. 

  • I have participated in PQRS/PQRI in the past. How do I get my feedback reports?

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

        

      CMS help desk resources:

      External User Services (EUS) – 7 am – 7 pm, ET
      Phone: (866) 484-8049
      TTY: (866) 523-4759
      Email:
      EUSsupport@cgi.com

      This service will help you in:

      • Registering/creating an Individuals Authorized Access to CMS Computer Services (IACS) account
      • Accessing an IACS account
      • Changing an IACS account
      • Approving users into an organization

      QualityNet Help Desk:

      7 am – 7 pm, CT
      Phone: (866) 288-8912
      Email: Qnetsupport@hcqis.org  

      This service will help you in:

      • General CMS PQRS & E-Prescribing Information
      • PQRS Portal Password Issues
      • PQRS feedback report availability and access

      Practices also may use a "quality reporting portal" to confirm whether a feedback report exists for their Tax Identification Number (TIN) or a National Provider Identifier (NPI). If a report exists, there are two ways to access it.

      1. Individual eligible professionals may call their local Medicare contractor and request that the contractor e-mail the report based on the individual NPI. Individual physicians in a group practice may individually use this option. For further information on this process, see CMS MLN educational article SE0922.

      2. Group practices that want to access feedback reports at the TIN level must once again use the quality reporting portal, which also requires a user ID and password to the Individuals Authorized Access to CMS Computer Services (IACS) system. Use the CMS IACS account management page to verify access to your IACS account.

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

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

        

      Click here to see a webinar on the PQRSwizard qualified registry.

      Click here to see a webinar on the Covisint PQRS qualified registry. 

      CMS is the authoritative source for PQRS information and has various educational resources available to assist physicians with their PQRS participation. Click here to learn more.

      Physicians may visit www.cms.gov/PQRS for the most up-to-date information.

  • Get the latest news on PQRS.

    • Register to Report in PQRS As a Group by Sept. 30
      For group practices of two or more: Now is the time to decide whether the practice will report data on quality measures as a group or individually for each physician.
    • PQRS: Deadline Nears for Group Registration
      Group practices that plan on participating in the 2014 Physician Quality Reporting System (PQRS) program year through the group practice reporting option must register by Sept. 30, 2014. This deadline does not apply to physicians who will participate in the 2014 PQRS program year as an individual eligible professional (EP) or to physicians who belong to a group practice that will participate in the 2014 PQRS program year as individual EPs.
    • PQRS: Deadline to Register to Participate in GPRO for 2014
      PQRS deadline to register to participate in GPRO for the 2014 PQRS program year.
    • Medicare Do’s and Don’ts
      The do’s and don’ts in this list may apply to you, depending on your specialty and/or circumstances. Note that some are timely!  
    • Didn't Report PQRS in 2013? You Can Still Avoid Penalty
      Eligible physicians 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.
  • Whom do I contact if I have more questions?