Physician Quality Reporting System (PQRS) Overview

This federal reporting program enables qualified providers to receive a combination of adjustments and incentive payments in order to improve the reporting quality of eligible professionals. Those who provide satisfactory quality measures for Medicare Part B Fee-for-Service can be compensated.

It is not necessary to sign up for this program; however specific criteria must be met to be eligible for CMS incentive payments. Here is a list of eligible professionals.

Physician Quality Reporting Measure Selection Considerations

You can begin measure selection by reviewing the 2012 Physician Quality Reporting System Measures List to identify which measures may be of greatest interest to your practice. At a minimum, the following factors should be considered when selecting reporting measures:

• Typical clinical conditions treated

• Care typically provided

• Normal care settings

• Quality improvement

2013 Physician Quality Reporting System (PQRS): Registry Reporting

Reporting on a minimum of 80 percent of qualified instances for more than 2 measures or reporting on a patient sample of 20 is required to qualify for the 2013 PQRS incentive payment.

You can escape the 2015 PQRS payment adjustment by fulfilling one of the following criteria:

1. Meet required reporting criteria for the 2013 PQRS incentive

2. Report on an individual valid measure or measures group

3. Agree to administrative claims-based analysis

Useful information on avoiding future PQRS payment adjustments is available on the CMS PQRS website.

Individual Measures

• For measure specifications, reference the 2013 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry.

• Choose two or more measures for submission that will positively impact practice quality.

• Group Practice Reporting Organizations using registry should make use of the 2013 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures.

Individual measures with a 0% performance rate are not considered satisfactory for reporting. To be included at least one patient for each individual measure must be reported.

Measures Groups (not for GPRO)

• Reference the 2013 Physician Quality Reporting System Measures Groups Specifications for measure groups. Measures groups specifications are different from those of the individual measures that form the group. Therefore, the instructions and instructions for measures group reporting are documented in a separate manual.

• Choose a minimum of one measures group for submission to qualify for an incentive payment.

• With 20 patients in the measures group only the majority have to be Medicare Part B FFS patients.

• Take a look at Getting Started with 2013 PQRS Reporting of Measures Groups. This document provides a series of options for reporting measures groups and can be used as a guideline for 2013 PQRS measures groups implementation.

Measure Specification Format

The measure specification format provides a great deal of flexibility for detailed explanation of reporting information.

1. Measure title – A list of codes and titles can be found in the 2013 PQRS Measure Specifications Manual for Claims and Registry.

2. Available reporting option for each measure – Enter C for Claims or R for Registry

3. Describe the measure

4. Reporting instructions include applicability, timeframes and frequency

5.Denominator statement, includes coding – CPT I code + ICD-9 code(s)

6.Numerator statement and coding options – CPT II code and/or G-code + CPT II modifier if applicable

7. Definition of terms when necessary

8. Measure rationale statement –Contact measure owner for further information.

9. Clinical evidence or clinical recommendations providing a basis of supporting criteria for the measure – Contact measure owner for further information.