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PQRS and Your Practice

What is PQRS?

PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). 

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). 

Beginning in 2015, the program also applies a payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services.  This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS.

What are the reportable PQRS measures?

The eligible quality measures under PQRS are listed on the CMS website and are not specialty-specific, i.e., a provider does not have to be a cardiologist to report on giving aspirin to a patient with acute myocardial infarction (AMI).  In addition, CMS will allow more than one participating provider to report on quality codes on the same patient.

The 2013 PQRS System Measures List identifies over 300 quality measures.  There are no new measures that apply to Emergency Medicine for 2013.  Note that gaps in measure numbering reflect retired PQRS measures that were not included in the updated list.

Why PQRS

PQRS gives participating EPs the opportunity to assess the quality of care they are providing to their
patients, helping to ensure that patients get the right care at the right time. By reporting PQRS quality
measures, providers also can quantify how often they are meeting a particular quality metric. Using the
feedback report provided by CMS, EPs can compare their performance on a given measure with their
peers.

Choosing How to Participate

The program provides an incentive payment to practices with EPs (identified on claims by their
individual National Provider Identifier [NPI] and Tax Identification Number [TIN]), or group practices
participating in the group practice reporting option (GPRO) who satisfactorily report data on quality
measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

Reporting Methods

To participate in the 2014 PQRS program, individual EPs may choose to report quality information
through one of the following methods:
    1. Medicare Part B claims
    2. Qualified PQRS registry
    3. Direct Electronic Health Record (EHR) using Certified EHR Technology (CEHRT)
    4. CEHRT via Data Submission Vendor
    5. Qualified clinical data registry (QCDR)

EPs should consider which PQRS reporting method best fits their practice when making this decision.

Group practices participating through the Group Practice Reporting Option (GPRO) in the 2014 PQRS
program year can participate through one of the following methods:

    1. Qualified PQRS registry
    2. Web interface (for groups of 25+ only)
    3. Direct EHR using CEHRT
    4. CEHRT via Data Submission Vendor
    5. CG CAHPS CMS-certified survey vendor (for groups of 25+ only)

Adjustments


EPs who do not satisfactorily report data on quality measures for covered professional services during
the 2014 PQRS program year will be subject to a 2% payment adjustment to their Medicare PFS amount
for services provided in 2016.

For more information about PQRS payment adjustments visit the Payment Adjustment Information
webpage.