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.
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).
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.
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.
CMS has created resources for eligible professionals participating in the Physician Quality Reporting System:
The following links are from past CMS National Provider Calls:
February 21, 2012: CMS subject matter experts provide a brief overview on claims-based reporting for both the PQRS and eRx Incentive Program.
January 17, 2012: CMS subject matter experts provide a brief overview on how the 2012 eRx payment adjustment will appear on the remiitance advice in addition to an overview of the self nomination process.
December 20, 2011: CMS subject matter experts provide a brief overview on EHR and registry based reporting options that are available for eligible professionals participating or looking to participate in the PQRS and/or eRx Incentive Program.
November 8, 2011: CMS subject matter experts provide an overview of the Medicare Physician Fee Schedule to address the 2012 PQRS and the eRx Incentive Program.
Please visit the Medicare website for more information about the PQRS. To alert IDSA to problems that should be raised with the Centers for Medicare and Medicaid Services, please e-mail IDSA staff.
PQRS Measures Finder Tool
Physician Compare Website
Incentive Payment Schedule
eRx Incentive Program
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