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PQRS and Medicare EHR Incentive Programs Guidance

Written by Kaitlyn Houseman | May 16, 2013

Guidance for Eligible Professionals: How to Participate in Both the Medicare EHR Incentive Program and PQRS in 2013 and Beyond

Providers who treat Medicare patients and bill for Part B services on the Medicare Physician Fee Schedule (PFS) may be eligible for two incentive programs at CMS: the Medicare EHR Incentive Program and the Physician Quality Reporting System (PQRS) program. CMS encourages you to read more to learn about the opportunity to participate in both.

About EHR

The Medicare EHR Incentive Program provides incentive payments to eligible professionals (EPs) that successfully demonstrate meaningful use of certified EHR technology.

About PQRS

PQRS is a reporting program that provides incentive payments to promote reporting of quality information by EPs.

Participating in Both in 2013

EPs who successfully participate in PQRS and EHR can receive an incentive in 2013 and avoid the 2015 payment adjustment for both programs.

To successfully demonstrate meaningful use for the Medicare EHR Incentive Program, EPs are required to report clinical quality measures (CQMs) as well as meaningful use measures.  In 2013, EPs may satisfy the meaningful use objective to report CQMs to CMS by reporting them through:

  1. Medicare and Medicaid EHR Incentive Programs’ web-based Registration and Attestation System
    • EPs who choose to report CQMs through the CMS Attestation system must still report information on individual quality measures or measure groups using one of the four reporting options in order to also participate in PQRS.
  2. Participation in the PQRS-Medicare EHR Incentive Pilot, which utilizes the 2013 PQRS EHR Measure Specifications
    • EPs who participate in the pilot may submit their meaningful use objectives through the CMS Attestation system, and then complete a single submission of CQMs to receive credit for both programs.

Participating in Both Programs in 2014 and Beyond

In 2014, the PQRS and EHR programs have overlapping participation guidelines, including the same quality measures, the same reporting criteria, and the option to use the same reporting mechanism.  The goal of this “alignment” is to simplify participation in both programs.

Here are some key considerations for PQRS and EHR alignment in 2014:

  • PQRS and EHR programs will align on the same set of eCQMs (64 total) and the same electronic specifications
  • All Medicare-EPs beyond their first year of demonstrating meaningful will be required to electronically report their CQM data to CMS for the EHR program
  • Submitting data electronically using 2014 certified EHR technology will meet the standards for both EHR and PQRS programs
  • Participating EPs will have the option to submit patient-level data (via QRDA I) or aggregate data (via QRDA III) using the same reporting mechanism for electronic reporting for both programs

We hope you will take action and participate in both programs this year. To learn more about PQRS and EHR, schedule a free consult with a GroupOne expert today.