Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

PQRS: Participation Is Up; Not Too Late to Start

Providers not already participating in the Physician Quality Reporting System (PQRS) for the 2014 reporting year may want to review the Centers for Medicare and Medicaid Services (CMS) 2016 PQRS Payment Adjustment Fact Sheet to ensure they will not lose 2.0% of their Medicare revenue for non-participation (which doubles to 4.0% for groups of 10 or more who are subject the Value-Based Payment Modifier program).

Since the claims-based reporting option for individual providers requires quality code submission on at least 50% of eligible claims for selected measures either to earn an incentive or avoid a penalty, it’s not too late for providers to get started immediately. Also, other reporting options for individuals and groups, like the registry or EHR reporting, also are still available to providers wishing to participate.

If you haven’t yet started participating with PQRS, visit the CMS “How to Get Started” web page. Also, for a complete list of all PQRS deadlines for the various reporting options, download the CMS PQRS Timeline.

According to a CMS report released early in April 2014, more than 430,000 professionals participated in PQRS for 2012, a 36 percent increase from 2011. As expected, PQRS participation generally is highest among professionals who see the most Medicare patients; 36 percent of all eligible professional participated in 2012, while professionals who treated at least 200 Medicare beneficiaries per year participated at a rate of 53 percent.

With the addition of payment adjustments for the 2013 reporting year, participation is expected to continue rising. More information about PQRS participation is available in the “2012 Physician Quality Reporting System and Electronic Prescribing Experience Report.”

CMS also is now accepting measures suggestions for future years of the PQRS. Measures submitted may also be considered for other quality programs, including the Value-Based Payment Modifier, Physician Compare, and others.

Measure suggestions submitted through June 30, 2014, will be considered for the 2014 Measures Under Consideration (MUC) list and could be included in the program as early as the 2016 reporting year. Unlike previous years, the call for measures will remain open indefinitely, and potential measures submitted after June 30, 2014, will still be reviewed for possible inclusion on the 2015 MUC list for the 2017 reporting year.

All measures submitted for consideration must include required supporting documentation as specified by CMS and available on the “Call for Measures” page of their website.

For more information, visit the “Physician Quality Reporting System” page on the CMS website.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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