• The CMS Physician Quality Reporting Systems (PQRS) program

    • TMA Offers Member Discounts for PQRS (Formerly PQRI) Reporting

      Participation in the Physician Quality Reporting System, formerly known as PQRS, does not have to be complicated or require complex coding systems and expensive manual processes. TMA endorses two 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 Measure Group reporting (11 of which must be Medicare Part B patients) or 80 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 for small practices and competitively priced with TMAs discounted rate: $199 for PQRSwizard, and $195 for Covisint PQRS (use discount code TMAPQRS13). The tools enable you to participate in the PQRS program without modifying your billing processes. On average, 2009 bonus payments for satisfactory reporters in the Physician Quality Reporting System were $1,956 per eligible professional.  See more: PQRS Discount Flyer (PDF)

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

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

        

      PQRS is a voluntary reporting program that pays bonuses to physicians and other eligible health care professionals who satisfactorily report data on quality measures in treating Medicare Part B patients. The program's intent is to get physicians used to documenting and reporting the care they already provide to patients.

      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.

      In 2015, physicians who do not report data to PQRS will see a 1.5-percent cut in their payments. That penalty increases to 2 percent in 2016 and subsequent years.

  • 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?

    • Reporting can be done via claims, through a qualified registry, or via electronic health records (EHRs).

        

      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. Qualified 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. It simplifies the process and allows the doctor to report on at least 20 patients rather than having to remember to include the special quality code on every claim they submit.

      Some physicians don't take advantage of PQRS and e-prescribing because they either don't know about them or believe they will be too much work, says Houston family physician David Auer, MD. "It sounds like it's going to be a hassle, but it's really amazingly simple," he said.

      Dr. Auer, a solo practitioner, has participated in PQRS for three years. He twice reported on preventive care measures and once on diabetes measures. Dr. Auer says reporting on the preventive care measures was very easy to do. It was a matter of spending a few minutes each with 30 patients to determine whether they were current on such preventive services as colonoscopies or mammograms, then entering the data into a registry.

      Click here for more information.

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

    • In some cases, certain measures or measure groups will be more transparent to a practice based on its Medicare population and clinical conditions most often treated.

        

      If this is not the case, we recognize that all practices and their patient mixes are different, and would recommend physicians contact their specialty medical society for the most relevant measures and/or measure groups on which they can report.

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

    • Physicians have the potential to earn an additional 0.5 percent through 2013 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.

  • 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@sdps.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?

        

      CMS recently posted several resources to help PQRS participants review feedback reports, as well as prepare practices that are considering participation in PQRS.

      Visit www.cms.gov/PQRS for the most up-to-date information.

      The American Medical Association has participation tools on its website to help physicians who want to take part in PQRS. Tools for each of the individual quality measures and measures groups that can be reported through claims-based submission are available.

      TMA recommends that physicians report to CMS via a qualified registry as those physicians have traditionally been more successful in reporting their clinical data.

  • Get the latest news on PQRS.

    • Experts to Explore Transformation of Health Care System
      Top state and national physician and health care leaders, elected officials, and candidates for statewide office will gather in one place this weekend —Texas Medical Association’s (TMA’s) 2014 Winter Conference.
    • 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.
    • PQRS: Submission Deadline for 2013 Claims-Based Reporting
      Submission Deadline for 2013 Claims-Based Reporting
    • CMS Extends PQRS Registration Deadline for Three Days
      Physicians have three more days to register for the Physician Quality Reporting System (PQRS) and avoid a 1-percent cut in Medicare payments.
    • How to Avoid the PQRS Penalty
      For practices not currently participating in the Medicare Physician Quality Reporting System, and who don’t want to use a qualified registry or electronic health record PQRS reporting mechanism, another Medicare penalty is looming. Take action now to sign up for a temporary mechanism to prevent it.
  • Whom do I contact if I have more questions?