Navigating PQRS Incentives and Penalties

Dermatologists who report at least three quality measures to Medicare’s Physician Quality Reporting System (PQRS) in 2013 will not only make themselves eligible for a bonus payment of 0.5 percent of their total Medicare Part B allowed charges, but can also possibly avoid a 1.5 percent payment reduction to be assessed in 2015. If a dermatologist wishes to only avoid the 2015 reduction, but not earn a 0.5 percent incentive, then he or she only needs to report one measure during the 2013 reporting year.

A dermatologist wishing to earn the additional PQRS incentive must report at least three measures.  Therefore, he or she only needs to report three of the four dermatology-appropriate measures (measures 137, 138, 224, and 265) and meet each of the chosen measures at least once to qualify for the incentive payment. This means that one must successfully perform the measure on at least one patient per measure to qualify for the incentive payment.  Each of the four dermatology measures can only be reported via electronic registry, for a full year reporting period (January 1-Decemeber 31, 2012).

To solely avoid the 2015 payment reduction, a dermatologist can report one measure. This can be done either via registry, or by adding a special quality measure code to a Medicare claim during the 2013 reporting year. Note that one cannot report the dermatology-appropriate measures via claims. If choosing to report via claims, one will need to research the other available measures on the CMS website.

CMS is also allowing practices of at least two providers to participate in PQRS as a group, under one tax identification number, for purposes of earning a 2013 incentive payment and/or avoiding the 2015 payment reduction. In order to participate in this program, known as PQRS Group Practice Reporting Option (GPRO), the practice must self-nominate via a dedicated CMS website that will become available before July 15. One can find more information at the CMS website at www.cms.gov/pqrs or by calling the QualityNet Help Desk at 1-866-288-8912. Note that the AAD PQRS registry is not able to support GPRO reporting at this time.