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CMS Physician Quality Reporting System (PQRS)

Bonuses available now, but you must start reporting in 2013 to avoid a penalty in 2015.


Bonuses and Future Penalties

2012 0.5% if no MOC; 1% if MOC*
2013 0.5% if no MOC; 1% if MOC*
2014 0.5%
2015 -1.5% if no successful reporting for 2013
2016 -2%

*The only PQRS-Maintenance of Certification (MOC) module from the American Board of Family Medicine is diabetes.

PQRIWizard

The AAFP offers a discount for members who use the PQRIWizard registry offered by CECity.

PQRS

  • Earlier referred to as Physician Quality Reporting Initiative (PQRI)
  • Requires both NPI and Tax ID #
  • Pay-for-reporting, not pay-for-performance
  • Initially required CPT II or ā€œGā€ codes along with billing codes on claims; now there are four ways to participate
  • Registry participation is the most promising path for small- and medium-sized practices
  • PQRS is not a substitute for local quality improvement efforts

PQRS Reporting Options

  • Medicare Part B claims-based reporting (CPT II or G codes)
  • Reporting to a CMS-approved registry (PQRIWizard is one option)
  • Via qualified electronic health record product
  • EHR data reporting through a qualified Physician Quality Reporting data submission vendor

Qualified Registries

A list of CMS qualified registries for 2012 (25-page PDF file; About PDFs) is available on the CMS web site.

Claims Reporting

For claims reporting: A 2012 Physician Quality Reporting System (PQRS) Toolkit is now available on the AMA web site. These tools include a description, specifications and data collection sheet for all PQRS claims measures, as well as links for the individual measures or measures groups.