Physician Quality Reporting System (PQRS) Incentive Program

Background

The 2006 Tax Relief and Health Care Act established a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficia­ries.

Eligibility

  • Physicians: defined as a doctor of medicine or osteopathy, a doctor of oral surgery or dental medicine, a doc­tor of podiatric medicine, a doctor of optometry, or a chiropractor;
  • Practitioners: defined as a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist (and anesthesiologist assistant), certified nurse midwife, clinical social worker, clinical psy­chologist, registered dietician, nutrition professional, or audiologist; and
  • Therapists: defined as a physical therapist, occupational therapist, or qualified speech-language therapist.

Maximum Incentive Payments

Eligible Professionals (EPs) who satisfactorily report on PQRS quality measures will earn an incentive payment based on a percentage of their total estimated Medicare Physi­cian Fee Schedule (PFS) allowed charges processed not later than 2 months after the end of the reporting period.

For reporting years 2012 through 2014, EPs who satisfactorily report PQRS measures will earn an incentive payment equal to 0.5 percent of allowed charges.
Additionally, for reporting years 2011 through 2014, EPs who satisfactorily report PQRS measures can qualify to earn an additional 0.5 percent incentive payment by participating in main­tenance of certification program and successfully completing a qualified maintenance of certification program practice assessment, more frequently than is required to qualify for or maintain board certification status.

Timeframe

The PQRS incentive payments are available until 2014.

Payment Adjustment

Beginning in 2015, EPs who do not satisfactorily report under the PQRS will be subject to a payment adjustment equal to 1.5 percent of their Medicare PFS allowed charges. The payment adjustment increases to 2.0 percent in 2016 and beyond.

Useful Links

PQRS Overview & Educational Resources – produced by CMS
Medicare EHR, PQRS, and eRx Incentive Program Comparison Tip Sheet – produced by CMS
2012 PQRS: EHR Reporting Made Simple describes EHR-based reporting and outlines steps that eligible professionals should take in selecting an EHR to work with for the 2012 program year.