Q: What is the Physician Quality Reporting System?
A: The Physician Quality Reporting System (PQRS), formerly known as PQRI, is a program developed by the Centers for Medicare and Medicaid Services (CMS) to provide a financial incentive bonus to physicians who report on best-practice quality measures for the Medicare patients they treat.
Q: If I participated in PQRS and did not earn an incentive, can I appeal to CMS?
A: CMS allows participants to request an informal appeal via the QualityNet Help Desk so your PQRS data can be reviewed to determine if a mistake was made. You can contact the QualityNet Help Desk at (866) 288-8912 (TTY (877) 715-6222) or at http://firstname.lastname@example.org. They are available Monday through Friday from 7 a.m. to 7 p.m. CT.
Q: How will the health care reform law affect PQRS?
A: The Patient Protection and Affordable Care Act will continue to offer incentives for participation through 2014. However, also in 2014, an eligible professional will have to report on at least three measures, on at least 50 percent of patients that apply to each measure, to avoid a 2.0 percent payment reduction in 2016.
Q: How much will my incentive payment be?
A: If a participant successfully meets all criteria of the PQRS program, he or she will receive a bonus of 0.5 percent of total allowed Medicare Part B charges to CMS for the calendar year.
Q: Is there a penalty associated with PQRS?
A: Yes, if one does not report at least at least three measures, on at least 50 percent of patients that apply to each measure in 2014, then he or she will be assessed a 2.0 percent payment reduction in 2016.
Q: How many measures do I have to report to earn an incentive?
A: Providers must report a minimum of nine measures to earn the incentive. There is no advantage to reporting more than nine.
Q: How many measures do I have to meet if I am reporting to earn an incentive?
A: You do not have to meet every measure, however:
- You must have greater than a 0 percent performance rate for all reported measures.
- Not every reported patient needs to meet all nine measures.
- Each of the chosen quality measures must have at least one eligible instance.
Q: How many measures do I have to report to avoid the 2.0 percent payment reduction in 2016?
A: The 2.0 percent payment reduction will occur in 2016, and will be based on your participation in 2014. To avoid this payment reduction, you have to report at least three measures, on at least 50 percent of patients who apply to each measure. This can be done either through a registry, or via claims (keep in mind that the dermatology-appropriate measures can only be reported via registry). Reporting three measures will only exempt you from the payment reduction; you still need to report nine measures to be eligible for the incentive.
Q: The dermatologist I work for told me I need to submit his or her PQRS information through a registry. What does that mean?
A: A registry is an electronic system that is built by an outside company (vendor) that allows practice staff to enter quality information online. All vendors have to be registered with CMS on a qualified list to report PQRS data.
Q: I participated in this program in the past using my claims forms; am I able to do that this year?
A: Some PQRS measures may be reported via claims, however, if you choose to report the dermatology-appropriate measures #137, #138, #224, #265, #337, then you must report via a registry. CMS determined that these measures can only be answered through an electronic registry in 2014. However, there are other PQRS measures that you may be able to report via claims.