PQRS (Physician Quality Reporting System) is a reporting program under the Centers for Medicare and Medicaid Services that uses a combination of incentive payments and negative payment adjustments to promote the reporting of quality information. The idea behind PQRS is to give participating Eligible Professionals (EPs) the opportunity to assess the quality of care they are providing to their patients. This helps ensure that patients are getting the right type of care, at the right time.
2015 marks the beginning of negative payment adjustments for those not participating in PQRS. If your practice is eligible and hasn't been reporting, now is the time to get started so that you can avoid more penalties down the road. We want to provide you with an overview to help you better understand PQRS and how it might affect your EHR workflow in the upcoming years.
What You Need to Know about PQRS and Your EHR Workflow
The Quick Facts
- PQRS is a voluntary reporting program and is not required for Meaningful Use
- If you choose to report, you must successfully do so on at least 50% of eligible insurances (Medicare Part B PFS) within a 12 month period
- There are 5 different methods of reporting
- Successfully reporting for the 2015 year will allow your practice to avoid payment adjustments in 2017
- PQRS data must come from one application. If you switch applications in the middle of the year, you will need to merge the data via a registry before submitting to the CMS.
A Closer Look at Incentives and Adjustments
EPs who successfully report quality measures data for services furnished during the 2014 reporting period at eligible to earn incentives up to .5% of their total covered Medicare Part B PFS services provided during the reporting period. Incentives for the 2014 reporting period will be provided to EPs in 2016.
If you haven't yet started reporting PQRS data, you can still start now and try to hit your numbers for the reporting period of 2015, which would clear you from adjustment penalties in 2017. But the longer you wait, the more likely it is that you won't hit your numbers for this year (50% of eligible insurances, which will include the days you've already missed reporting on so far this year). For more information on incentives and adjustments check out this CMS resource.
EPs may choose to report through one of the following methods:
- Direct using EHR
- Medicare Part B Claims
- Qualified Registry
- CEHRT via Data Submission Vendor (DSV)
- Qualified Clinical Data Registry (QCDR)
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