Medicare's Physician Quality Reporting System was developed by the Centers for Medicare and Medicaid Services (CMS) to apply a payment reduction to eligible professionals (EPs) who do not satisfactorily report data on quality measures for the Medicare Part B patients they treat.
2015 Physician Quality Reporting
In 2015, eligible professionals (EPs) must report at least nine quality measures that cover at least three of the National Quality Strategy Domains. An EP is any provider who bills Medicare under his or her own NPI. If an EP works under multiple tax ID numbers (TINs), he or she must report PQRS under each one.
The potential payment reduction for not reporting PQRS in 2015 is 4-6% of Medicare charges, depending on the size of the practice (to be applied in 2017). This amount is comprised of the 2% PQRS payment reduction, and the 2-4% Value Based Payment Modifier (VBPM) reduction. For solo practitioners and groups of 2-9 physicians, the potential payment reduction is 2% of Medicare charges for PQRS and a 2% VBPM payment reduction. Groups of 10 or more physicians will automatically receive a 4% VBPM payment reduction, in addition to a 2% reduction. There is no longer an incentive available to eligible providers who satisfactorily report PQRS measures.
CMS also detailed a new requirement stating that at least one of the reported measures must be from a set of cross-cutting measures. Each measure must be reported for at least 50 percent of the EP’s Medicare Part B fee-for-service patients seen Jan. 1 through Dec. 31, 2015 for which the measure applies. The five dermatology-specific measures, #137, #138, #224, #265, and #337, from the 2014 program will continue. Additionally, there will be a new pathology measure that applies to melanoma: measure #397. This measure looks at whether the EP has documented pathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness and ulceration and for pT1, mitotic rate.
If less than nine measures apply, EPs must go through the Measure Applicability Validation (MAV) process. CMS uses this process to evaluate whether or not EPs could have reported on additional measures, and determine whether or not they satisfied reporting requirements.
- See registry MAV requirements here
- View the CMS MAV Training Course here
The 2015 QRS registry is able to report 18 measures.
- Download a list of these measures here
- View the final specifications for these measures here
The QRS registry will only allow users to choose a combination of nine measures that cover at least three National Quality Strategy domains. The quality domains are:
- Patient Safety
- Person and Caregiver-Centered Experience and Outcomes
- Communication and Care Coordination
- Effective Clinical Care
- Community/Population Health
- Efficiency and Cost Reduction