Q: What is the Physician Quality Reporting System?
A: The Physician Quality Reporting System (PQRS), formerly known as PQRI, is a program developed by the Centers for Medicare and Medicaid Services (CMS) to provide a financial incentive bonus to physicians who report on best-practice quality measures for the Medicare patients they treat.
Q: If I participated in PQRS and did not earn an incentive, can I appeal to CMS?
A: CMS allows participants to request an informal appeal via the QualityNet Help Desk so your PQRS data can be reviewed to determine if a mistake was made. You can contact the QualityNet Help Desk at (866) 288-8912 (TTY (877) 715-6222) or at http://email@example.com. They are available Monday through Friday from 7 a.m. to 7 p.m. CT.
Q: How will the health care reform law affect PQRS?
A: The Patient Protection and Affordable Care Act will continue to offer incentives for participation through 2014. However, an eligible professional will have to report on at least one measure for one patient for the 2013 reporting period to avoid the penalty in 2015.
Q: How much will my incentive payment be?
A: If a participant successfully meets all criteria of the PQRS program, he or she will receive a bonus of 0.5 percent of total allowed Medicare Part B charges to CMS for the calendar year.
Q: Is there a penalty associated with PQRS?
A: Yes, if one does not report at least one measure for one patient in 2013, then he or she will be assessed a 1.5 percent payment reduction in 2015.
Q: How many measures do I have to report to earn an incentive?
A: Providers must report a minimum of three measures to earn the incentive. There is no advantage to reporting more than three.
Q: How many measures do I have to meet if I am reporting to earn an incentive?
A: You do not have to meet every measure, however:
- You must have greater than a 0 percent performance rate for all reported measures.
- Not every reported patient needs to meet all three measures.
- Each of the quality measures must have at least one eligible instance.
Q: How many measures do I have to report to avoid the 1.5 percent payment reduction in 2015?
A: The first payment reduction will occur in 2015, and will be based on your participation in 2013. To avoid this first payment reduction, you have to report — at a minimum — at least one measure, one time. This can be done either through a registry or via claims (keep in mind that the dermatology-appropriate measures can only be reported via registry). Reporting one measure, one time will only exempt you from the payment reduction; you still need to report three measures to be eligible for the incentive.
Q: The dermatologist I work for told me I need to submit his or her PQRS information through a registry. What does that mean?
A: A registry is an electronic system that is built by an outside company (vendor) that allows practice staff to enter quality information online. All vendors have to be registered with CMS on a qualified list to report PQRS data.
Q: I participated in this program in the past using my claims forms; am I able to do that this year?
A: If you choose to report the dermatology-appropriate measures #137, #138, #224, and/or #265, then you must report via a registry. CMS determined that these measures can only be answered through an electronic registry in 2013. However, there are other PQRS measures that you may be able to report via claims.
Q: If I only wish to avoid the penalty, and do not wish to report through a registry, are there other PQRS measures I may be able to report on my claims?
A: You can find a listing of other measures that may be applicable to dermatology practices here.