Program Overview
The Physician Quality Reporting System (PQRS) is a voluntary reporting program that provides an incentive payment to physicians and other eligible professionals who satisfactorily report data on quality measures for covered professional services. PQRS, formerly the Physician Quality Reporting Initiative (PQRI) was first implemented in 2007. Please use links below for detailed program information.
2012 PQRS
To participate in the 2012 Physician Quality Reporting, individual eligible professionals may choose to report information on individual Physician Quality Reporting quality measures or measures groups: (1) to CMS on their Medicare Part B claims, (2) to CMS via a qualified Physician Quality Reporting registry, or (3) to CMS via a qualified electronic health record (EHR) product (this option is limited to 50 measures (largely not reportable by radiologists).
Changes to the program overall in 2012 relevant to radiology:
- Elimination of the six-month reporting period, except for measures group reporting through a CMS-qualified PQRS registry. The only reporting period for individual measures will be January 1 – December 31, 2012.
- Change to claims-based reporting – measures reported with a 0 percent performance rate will not be counted towards successful reporting. This was true in previous years for registry reporting only.
- In 2012, there is one new measure potentially reportable by radiologists who perform biopsies: #265 Biopsy Follow-Up, according to the CPT I codes included in the measure denominator. The measure is described as the percentage of patients whose biopsy results have been reviewed and communicated to the primary care or referring physician and patient by the performing physician. The measure is only reportable through a registry and cannot be submitted through claims reporting.
- There are a few code updates, terminology clarifications and verbiage changes to some measures potentially reportable by diagnostic radiologists, interventional radiologists and radiation oncologists. CLICK HERE
Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data for services furnished during a 2012 reporting period will qualify to earn an incentive payment equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered services furnished during that same reporting period.
Incentive payments have been authorized for PQRS through 2014; however the incentive is authorized on a declining scale as shown below. After 2014, a payment adjustment, i.e. penalty, will be made for professionals who do not successfully report on the quality measures.
- 2012-2014: 0.5 percent
- 2015: 98.5% payment adjustment
- 2016 and beyond – 98 percent payment adjustment
PQRS Maintenance of Certification (MOC) Program Incentive
The Affordable Care Act (ACA) also required CMS to provide an option for a physician to report data on quality measures through a Maintenance of Certification (MOC) Program operated by a specialty body of the American Board of Medical Specialties (ABMS). An incentive payment of .5%, additional to the PQRS bonus, is authorized for years 2011 through 2014 if certain requirements are met, including:
- Must first have successfully participated in PQRS for a 12-month period, i.e. January 1 – Dec 31 (not the 6 month reporting option)
AND
- More frequently than is required to qualify for or maintain board certification:
- Participate in a Maintenance of Certification Program and
- Successfully complete a qualified Maintenance of Certification Program practice assessment, which must include a survey of patient experience with care as part of the practice assessment.
The additional .5% is authorized through 2014. Beyond 2014, participation in the PQRS MOC Program option may be incorporated into a "composite of measures" of quality furnished under the physician fee schedule value-based payment modifier. For more information see link below.
Changes to the Maintenance of Certification (MOC) Program PQRS Incentive for 2012
CMS "simplified" the requirements for participation in the MOC Program Incentive by making the "more frequently" requirement apply to any one component instead of all four components of an MOC Program (excluding Part 1, Maintenance of Licensure). CMS also indicates that with respect to the practice assessment (Part IV) that at least one practice assessment activity should be completed every year the eligible professional wishes to receive the incentive.
The additional 0.5 percent is authorized through 2014 (as is a 0 .5 percent bonus for PQRS participation itself). Beyond 2014, participation in the PQRS MOC Program option may be incorporated into a "composite of measures" of quality furnished under the physician fee schedule value-based payment modifier.