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PQRS – Reporting, Format and Tools

June 12, 2014

PQRS - Reporting, Format and ToolsBegun as a voluntary program in 2007 by CMS, the Physician Quality Reporting System (PQRS), offered fixed financial incentives to physician and non-physician providers who gathered and reported data metrics for the covered services their practices provided to Part B beneficiaries of traditional Medicare. Through reporting year 2012, a 1.5 percent bonus was paid for successful participation, based on the estimated total allowed charges for all cover services within the reporting period.

The structure of PQRS has changed since its inception, driven by new laws, notably 2010’s Affordable Health Care Act (ACA). What before ACA was a voluntary program that incentivized participation through payments to practices has segued into a de facto mandatory program. Those practices not in compliance or who don’t participate will be penalized. A 2014 chart from CMS shows historic changes to PQRS’s incentive structure. (Incentives and penalties are assessed two years after the reporting year.)


0.5% (performance year for 2015 penalty)


0.5% (performance year for 2016 penalty)






Physicians who elect not to participate or are found unsuccessful during the 2013 program year, will be charged a 1.5 percent payment penalty, and 2 percent penalty each year thereafter. 

To avoid this, practitioners should become familiar with what data is assessed, how it’s defined and reported, and what tools or services can aid them in ensuring the data they submit to CMS for review is selected and submitted in compliance with PQRS standards.

Reporting Format: Individual Measures or Measures Groups

CMS Quality assessments criteria, documentation and procedures are extensive. The structure of the data assessed falls into two categories: individual measures or measure groups. Practices may choose either for their assessments. Practitioners select as reporting options either nine individual measures out of 348 across three National Quality Standards (NQS) domains, or one measures group. For 2014, measures groups are only reportable via a qualified registry. This year, 2014, there are 25 measures groups, such as General Surgery, Total Knee Replacement and Optimizing Patient Exposure to Ionizing Radiation.

Choosing How to Report

For 2014, practitioners may choose from five reporting options:

1. Medicare Part B claims

Practices or their claims vendors report the selected quality data codes (QDCs) with their claims, with a minimum of 9 applicable measures across 3 NQS domains.

2. Qualified PQRS registry

These are “self-qualifying” organizations approved by CMS and ready to support submission of PQRS data to CMS. They attest that they’re able to serve individual and group practitioners. As noted above, measures groups’ data must be submitted through a registry.

3. Direct Electronic Health Record (EHR) using Certified EHR Technology (CEHRT)

PQRS data may be sent directly to CMS via a Stage Two Certified EHR system.

4. CEHRT via Data Submission Vendor

This is new in 2014. EHR PQRS data from a practice’s Certified EHR system may be submitted to CMS through an approved CEHRT vendor.

5. PQRS Registry Systems Tools

A number of registries offer practices an online PQRS submission tools for a nominal fee. The vendors often equate them to PC-based tax preparation tools. These software packages typically collect either group or individual measures, validate the data, submit it to CMS, and advise acceptance or rejection and the reason for rejection. Suitable for small to medium-sized practices, these tools are offered to members of various medical associations. The American Associations of Physicians PQRSSmartWizard is typical of such products. Software that reports PQRS data unique to specialists’ practices is also readily available. The American Academy of Dermatology, for example, offers a dermatology-specific PQRS submission tool.

Given the mandated conversion to EHR systems now well underway, we should expect increasingly more PQRS reporting to shift to EHR systems, either directly from larger practices, or through CHERT vendors for smaller group or individual practices.


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