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Physician Quality Reporting System (PQRS) and Value-based Modifier

Why should I care about PQRS?

PQRS provides a structured means for participants to assess their performance on specific quality measures, and the opportunity to use CMS feedback to compare their performance with peers nationwide.

Through PQRS, CMS distributes incentive payments for high quality care. Beginning in 2015, the program also applies a payment adjustment (penalty) to eligible professionals who do not satisfactorily report data.

2016 is the final year of the EHR Incentive Program. Recent legislation is changing how clinical practices across the United States will be paid.

Why should I Submit PQRS Data?

PQRS quality reporting can affect your future Medicare reimbursement rates for the individual providers in your practice, clinic or hospital as a whole. PQRS reporting (or non-reporting) affects payments two years later. PQRS data submitted for the 2015 calendar year will affect 2017 reimbursement rates through both a payment adjustment and the value modifier.

How do I send data to PQRS?

CMS offers advice on How to Get Started as well as details about PQRS Measures Codes.

Individual providers

  • Medicare Part B claims
  • Certified EHR Technology (CEHRT)—directly or via a data submission vendor
  • Qualified PQRS registry
  • Qualified clinical data registry (QCDR)

Practice groups

  • Certified EHR Technology (CEHRT)—directly or via a data submission vendor
  • Qualified PQRS registry
  • Web interface (for groups of 25+ only)
  • CG CAPHS CMS-certified survey vendor (for groups of 25+ only)
     

Which quality measures should I report?

Qualis Health is helping Practice Innovation Network members report our program measures via EHR.

The types of measures reported under PQRS change from year to year. The measures generally vary by specialty, and focus on areas such as care coordination, patient safety and engagement, clinical process/effectiveness, and population/public health. They can also vary by reporting method. Review the current measures, and factors to help you decide which to report, on the PQRS measures page.

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