2012 PQRS Program Overview

Overview of the PQRS incentive payment program for EPs who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries.

What Is the Financial Incentive for PQRS?

The 2012 incentive payment will be 0.5% of all Medicare Part B physician fee schedule-covered professional services, not just on the claims where the performance measures quality data codes are applied. A 1.5% reduction in all Medicare fee-for-service payments for not participating in PQRS will begin in 2015.

Reporting Periods

• 12 months - January 1, 2012 - December 31, 2012 (available for the 30 Patient Sample Method, the 50% Patient Sample Method via Claims, and the 80% Patient Sample Method via Registry)
• 6 months - July 1, 2012 - December 31, 2012 (available only for the 80% Patient Sample Method via Registry).

Reporting Methods

• Registry - must satisfactorily report on at least 80% of eligible instances
• Electronic Health Record (EHR) - must satisfactorily report on at least 80% of eligible instances
• Claims - must satisfactorily report on at least 50% of eligible instances

Who qualifies for PQRS?

Eligible professionals:
Physicians: Doctor of Medicine, Osteopathy, Podiatric Medicine, Optometry, Oral Surgery, Dental Medicine, Chiropractic
Practitioners: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Anesthesiologist Assistant, Certified Nurse Midwife, Clinical Social Worker, Clinical Psychologist, Registered Dietician, Nutrition Professional, Audiologists
Group Practices (GPRO) - 25 or more eligible professionals

Is Registration Required?

No sign up or preregistration.

Measures and Measure Groups

For 2012, determine which PQRS reporting option in each category best fits your practice:

1. Select either claims-based or registry-based reporting.
2. Select either three individual measures or a measures group.

Requirements for Payment

Eligible professionals must choose and successfully report information on individual PQRS measures or measure groups:

1. to CMS on their Medicare Part B claims,
2. a qualified Physician Quality Reporting registry, or
3. to CMS via a qualified electronic health record (EHR) product.

PQRS Payment Reduction:

Despite strong opposition from the physician community, CMS finalized that it will use CY2013 as the reporting period for the 2015 PQRS payment penalty. CY 2013 (Jan. 1, 2013, through Dec, 31, 2013) will be the reporting period for the 2015 payment reduction (negative 1.5 percent) if CMS determines that an eligible professional or group practice has not satisfactorily reported data on quality measures.

Informal Appeals Process:

For 2012, an eligible professional must request an informal review within 90 days of the release of his or her feedback report, via a web-based tool, the communication support page. Information on the communication support page, including the link to the page, will be available at http://www.cms.gov/PQRS/