PQRS Information (Resource 327)

It is essential for healthcare providers to understand how the Physician Quality Reporting System (PQRS) affects their practice. All Eligible Professionals (EPs) who did not satisfactorily reported data on quality measures for covered professional services in 2014 your CMS payment will incur a 2% PQRS penalty (payment cut) om 2016. This PQRS non-participation payment penalty of 2% continues (based on PQRS participation two years ago) for as long as you do not participate in the PQRS program.

In an effort to improve quality of care in nursing home, CMS has been reviewing PQRS quality measures and offering provider training through a variety of mediums. Antipsychotic drug use is just one of the measures being reviewed. The MLN Connects Provider eNews for February 12, 2015 included the following notice about the trends in antipsychotic drug use and the results are promising:

Antipsychotic Drug use in Nursing Homes: Trend Update

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the 2014 PQRS data submission timeframes. 

2015 PQRS Quality Measures

Measures Codes

Measures codes contain information about Physician Quality Reporting System (PQRS) quality measures, including detailed specifications and related release notes for the individual PQRS quality measures and measures groups and other measures-related documentation needed by individual eligible professionals for reporting the PQRS measures through claims or qualified registry-based reporting.

PQRS FAQ (resource 321)

PQRS participation is important for healthcare providers. Several types of payment adjustments may be applied depending on how well providers meet PQRS criteria. To avoid negative payment adjustments or even gain postitive payment adjustments (Value Based Modifier) by CMS, healthcare providers need to successfully participate in the CMS Physician Quality Reporting System (PQRS).

For detailed information about this program, please refer to Chapter 2.5 of the Behavioral Health DeskBook.

Per Centers for Medicare and Medicaid Services (CMS), VSAC is the official repository for Value Sets that support 2014 Meaningful Use Clinical Quality Measures (CQMs). VSAC will also host other value sets such as Routes of Administration and Patient Assessment Instruments in the near future.

Yes, earned incentive payments will be deducted by 2%; President Obama has required this by law.  President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, PQRS incentive payments made to eligible professionals and group practices have been reduced by 2%.

This 2% reduction affected PQRS incentive payments for reporting periods that ended on or after April 1, 2013. All 2014 incentive payments are subject to sequestration.

Physician Quality Reporting System (PQRS) 2nd Quarter interim Feedback Dashboard reports are now available.  For eligible professionals and submitted data for claims sent in January 01, 2014 and June 30, 2014.  Data is available on a quarterly basis in order to monitor the status of claims-based individual measures. Dashboard data does not indicate whether or not an incentive payment was earned.

CMS is pleased to announce that the 2013 Physician Quality Reporting System (PQRS) incentive payments are now available for eligible professionals and group practices who submitted data for Medicare Physician Fee Schedule Part B services between January 1, 2013 and December 31, 2013. The PQRS incentive payments are for EPs and group practices who met the PQRS satisfactory reporting criteria, regardless of participation in another program (i.e., Medicare Shared Savings Program Accountable Care Organization, Comprehensive Primary Care Initiative, etc.).

CMS has added more PQRS training modules to help simplify the process, including one for beginner, intermediate and advanced PQRS reporting.  The modules are designed to help you find the information you need to satisfactorily participate in PQRS and other programs that offer incentive payments in 2014.


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