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  • Physician Quality Reporting System Resources

    Under the Physician Quality Reporting System (PQRS), physicians may increase their total Medicare payments in 2011 by 1.0 percent by choosing one reporting option and successfully reporting on applicable quality measures. Medicare payments to physicians who do not report on PQRS measures will be reduced beginning in 2015.

    Click here for the PQRS schedule of payment incentives and penalties. IDSA and HIVMA strongly encourage members to take advantage of the voluntary nature of the PQRS before payment penalties begin.  

    Medicare is required to transition the PQRS to a mandatory pay-for-performance program that pays physicians differentially based on their quality and cost of care. This change will be instituted over a two year period beginning in 2015. Cost and quality data will be shared with providers through confidential reports and with their patients through a new Physician Compare Website: the new website currently shows whether a particular physician reported on PQRS measures, but plans are underway to add eRx reporting later in 2011 and additional quality/cost indicators in future years.

    This presentation (Overview of PQRS) provides an overview of the Medicare PQRS and includes a brief background of the program, a look at the program website and documentation, high-level steps to get started, available resources, and who to contact for help.


    PQRS Reporting Options and Instructions

    The 2011 PQRS includes eight distinct reporting options, including claims- and registry-based options. No registration is required to participate in the PQRS. Physicians can participate by adding the appropriate quality-data codes (HCPCS G-codes or CPT Category II codes) to the associated diagnoses and covered services. Click on the charts below for more information about the available reporting options. Claims-Based Reporting Options  

    Under the claims-based reporting options, quality-data code (QDC) line items should be submitted with a charge of zero dollars ($0.00 or $0.01). QDC's should be submitted on line 24 of the electronic 837-P, or on line 24D of the CMS 1500 form if you are authorized to submit paper claims.

    Detailed instructions on how to fill out a Medicare claim (CMS-1500) to ensure accurate PQRS reporting:

    Contact individual qualified registries (PDF) and qualified Electronic Health Record Vendors (PDF) for information on their specific reporting processes. Medicare data reveals that physicians who reported on PQRS measures through a "qualified registry" are much more likely to earn incentive payments than their peers who choose the claims-based reporting option.


     Practices of two or more eligible professionals also have the option of self-nominating for the Group Practice Reporting Option (GPRO II).  

    PQRS Measures Reportable by ID Physicians

    IDSA and HIVMA have compiled a summary of measures that may be relevant to your practice. Please visit the PQRS Measure Specifications (Log-in Required) tool for a list of these measures as well as for more detailed reporting information, including measure-specific descriptions and coding instructions. Individual ID/HIV physicians' ability to report on specific measures depends on their service mix and patient population.

    ID-Specific PQRS Reporting Examples

    The following examples have been developed to help infectious diseases and HIV physicians understand how the various PQRS reporting options and measures may be applicable to their service mix and patient population.

    Additional Information

    CMS has created resources for eligible professionals participating in the Physician Quality Reporting System (PQRS):


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