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Physician Quality Reporting System - PQRS

 

The Physician Quality Reporting System (Physician Quality Reporting or PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments (penalties) to promote reporting of quality information by eligible professionals.

 

  • Voluntary Reporting Program
  • No Sign up or Pre-Registration required
  • Prior to 2015 Incentives are provided to eligible professionals (EPs) who satisfactorily report data on quality measures
  • Incentive applies to all covered Physician Fee Schedule services furnished to Medicare Part B beneficiaries

 

 

Physicians who qualify, may earn a bonus payment on all allowable Medicare Charges
  • Incentive for 2013 = 0.5%
  • Incentive for 2014 = 0.5%

 

 

CHANGES TO PQRS in 2015 and beyond

 

Beggining in 2015 bonuses will no longer be given for successful participation in PQRS. However, successful participation will prevent a 2% loss from their total Medcicare payments two years in the future. For example: successful PQRS in 2015 = no penalty in 2017.

 

 

THE FUTURE OF PQRS - Medicare Access and CHIP Reauthorizaion Act of 2015 (MACRA)


MACRA extends PQRS from 2015 - 2018

Authorizes end of PQRS in 2018

Begins new program in 2019, Merit-based Incentive Payment System (MIPS)
MIPS incorportaes some aspects of PQRS

 

 

 

PQRS 2016

 

If you are not successful in reporting PQRS in 2016 you will be penalized in 2018 on Medicare Reimbursements!

For 2016, most PQRS reporting options require an EP or group practice to report 9 or more measures including one cross-cutting measure 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

 

To be a successful PQRS provider during 2016 and avoid the payment penalty in 2018 you must:

 

1) Report accurately on 9 PQRS measures 1/2 the time that they apply based on diagnosis code and procedure code

2) Report on at least one quality measure from the "cross cutting" measure list.

 

 

Penalties for not doing PQRS began in 2015

 

2015 PQRS Penalty

  • 1.5% penalty on all Mediare Part B Physician Fee Schedule Services
  • Penalties are based on performance in 2013
  • To avoid the 2015 PQRS payment penalty you must submit one valid PQRS measure during 2013

 

2016 PQRS Penalty

  • 2.0% penalty on all Mediare Part B Physician Fee Schedule Services
  • Penalties are based on performance in 2014
  • To avoid the 2016 PQRS payment penalty you must submit three valid PQRS measure 1/2 the time that they apply during 2014

 

2017 PQRS Penalty

  • 2.0% penalty on all Mediare Part B Physician Fee Schedule Services
  • Penalties are based on performance in 2015
  • To avoid the 2017 PQRS payment penalty you must submit nine valid PQRS measure 1/2 the time that they apply during 2015

 

2018 PQRS Penalty

  • 2.0% penalty on all Mediare Part B Physician Fee Schedule Services
  • Penalties are based on performance in 2016
  • To avoid the 2018 PQRS payment penalty you must submit nine valid PQRS measure 1/2 the time that they apply during 2016

 

 

 

 

 

Need Help Getting Started with PQRS? Click Here

 

 

 

Click Here To Download 2016 PQRS Codes For Eye Care Providers

 

 

 

Click Here To Download 2016 PQRS Flow Charts To Help With Billing

From 1/1/2016 - 12/31/2016 (ICD 10 Codes)