How to participate in PQRS?
The Physician Quality Reporting System (PQRS) is a health care quality standard that uses incentive payments and payment adjustments to encourage eligible professionals (EPs) to report on particular quality measures.
Just start, no need to sign-up or pre-register
An individual EP will not require signing-up or pre-registering for participation in the program. However, earning incentives and avoiding PQRS Penalties requires the EP to satisfactorily fulfill the reporting criteria of the CMS.
Select a reporting method
For program participation, individual EPs will have to report through either of these methods:
1. Medicare (Part B) claims
2. A qualified PQRS registry
3. Directly through Electronic Health Record (EHR) via Certified EHR Technology (CEHRT)
4. CEHRT through a Data Submission Vendor
5. Qualified clinical data registry (QCDR)
You must select the method that is most suited for your practice to make this decision.
For group practices who want to participate via the Group Practice Reporting Option (GPRO), they need to adopt one of these methods:
1. Through a Qualified PQRS registry
2. Web interface for larger groups (25+ provider groups)
3. Direct EHR via CEHRT
4. CEHRT through a Data Submission Vendor
5. CG CAHPS CMS-certified survey vendor (25+ provider groups)
Select your reporting measures
The CMS, provider associations and several quality groups are responsible for formulating quality measures for EPs and group practices.
When selecting these reporting measures, EPs must keep in mind factors including commonly treated clinical conditions at your practice, types of care provided at your practice (e.g. preventive and chronic), the care settings, the year’s quality enhancement goals, and other reporting programs that you are using or considering (e.g. Meaningful Use).
Submit data and receive incentives or payment adjustments
EPs who satisfactory report data according to PQRS quality measures data through any of these reporting measures could earn incentives (until 2014). Similarly, those unable to do so will face a payment adjustment to their Medicare (Part B) PFS for services provided after a lag of two years.
Ask for Feedback Reports
You can also request to receive NPI-level PQR feedback reports on reporting rates, clinical performance, etc. You can access these reports via the CMS web portal in the year following the year of reporting.
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