American Society of Hematology

Physician Quality Reporting System

The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI) is a reporting program administered by the Centers for Medicare & Medicaid Services (CMS) that provides incentive payments or payment adjustments to promote the reporting of quality measures by eligible physicians (EPs) and other practitioners. In 2013 - 2014, EPs and other practitioners who satisfactorily report data on quality measures for covered services furnished during a reporting period (one year) will receive a 0.5 percent incentive payment. A payment adjustment (reduction) of -1.5% will occur in 2015 for those who do not satisfactorily submit quality data in 2013 and a 2 % payment penalty every year thereafter (based on lack of participation or unsuccessful participation 2 years prior). EPs can report individual measures or measure groups through one of three reporting mechanisms: registry-based reporting, claims-based reporting, and electronic health record (EHR)-based reporting. PQRS is applicable for Medicare Part B patients only and not for Medicare HMO products or for other insurance products.

2013 Reporting Options

Registry Reporting - Eligible professionals may report on either individual measures or measure groups each year. Providers reporting individual PQRS measures through a registry, such as ASH's PQRS Pro, must submit patient data for 80 percent or more of their patients on at least three individual measures to be considered "successful" participants. Providers reporting data for measure groups must submit patient data for at least 20 Medicare patients (11 of which need to be Medicare) on one measure group to be considered "successful" participants. Submitting for the incentive payment will successfully avoid the -1.5% Payment Adjustment (reduction) in 2015. Providers can also submit at least one patient for at least one measure to avoid the -1.5% payment adjustment (reduction) in 2015. This option, however, will not result in an incentive payment for 2013.

- Eligible professionals may report on either individual measures or measure groups each year. Providers reporting individual PQRS measures through a registry, such as , must submit patient data for 80 percent or more of their patients on at least three individual measures to be considered "successful" participants. Providers reporting data for measure groups must submit patient data for at least 20 Medicare patients (11 of which need to be Medicare) on one measure group to be considered "successful" participants. Submitting for the incentive payment will successfully avoid the -1.5% Payment Adjustment (reduction) in 2015. Providers can also submit at least one patient for at least one measure to avoid the -1.5% payment adjustment (reduction) in 2015. This option, however, will not result in an incentive payment for 2013.

Claims Based Reporting - Eligible professionals may report on either individual measures or measure groups each year. Providers must report at least 3 individual PQRS measures, or 1-2 measures if less than 3 apply to the eligible professional, for at least 50% of applicable Medicare Part B Fee-for-Service (FFS) patients of each eligible professional. Measures with a 0% performance rate will not be considered satisfactorily reported for incentive eligibility. Providers reporting data for measure groups will be required to submit one measures group for 20 applicable Medicare Part B FFS patients of each eligible professional. Measures Groups containing a measure with a 0% performance rate will not be counted. To avoid the -1.5% payment adjustment (reduction) in 2015, providers can report at least one measure via claims. This option, however, will not result in an incentive payment for 2013.

EHR Based Reporting - Providers must report at least 3 individual PQRS measures, for at least 80% of the eligible professional's Medicare Part B FFS patients seen during the reporting period to which the measure applies. An individual measure with a 0% performance rate (100% for inverse measures) will not count as a reported measure when determining incentive eligibility. Another EHR reporting option is the PQRS Medicare EHR Incentive Pilot whereby providers must report on all 3 Medicare EHR Incentive Program core measures. If the denominator for 1 or more of the core measures is 0, report on up to 3 Medicare EHR Incentive Program alternate core measures; and report on 3 (of the 38) additional measures available for the Medicare EHR Incentive Program.

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Current Resources from CMS

2013 PQRS Program Participation Fact Sheet
CMS has released a new fact sheet on participating in the 2013 PQRS program. The PQRS Overview fact sheet outlines information on how to participate in PQRS, as well as steps for selecting quality measures and reporting methods. Eligible professionals can also learn more about incentive payments for satisfactory reporting, payment adjustments beginning in 2015, and how to access and view feedback reports. The fact sheet also provides information on the Maintenance of Certification and Value Based Payment Modifier (VBPM) programs.

Request a Review of 2012 PQRS Participation Results
Eligible professionals (EPs), designated support staff/vendors, and group practices who submitted data for the 2012 Physician Quality Reporting System (PQRS) program can now request to have an informal review of their 2012 PQRS reporting performance.

An informal review may be requested if the feedback report reveals that the EP or group practice did not earn the 2012 PQRS incentive payment when they believe they should have, or when they believe the payment amount was incorrect. Informal review requests will be accepted from November 1, 2013 through February 28, 2014.

In order to request an informal review of 2012 PQRS performance, CMS must receive a valid informal review request via the web-based tool, Quality Reporting Communication Support Page by selecting "Create Informal Review Request."

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PQRS Resources

Center for Medicare and Medicaid Services' PQRS Web Site
The CMS website's PQRS section has numerous useful links and documents.

CY 2014 Medicare Physician Fee Schedule (PFS) Final Rule Slide Presentation
A slideset on the CY 2014 Medicare Physician Fee Schedule (PFS) Final Rule as presented by CMS on December 17, 2013.

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