CMS Physician Quality Reporting System (PQRS)

A note about the physician quality reporting system:

The last performance year for the physician quality reporting system (PQRS) under Medicare was 2016. PQRS under Medicare has been consolidated into the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act (MACRA) starting in 2017.

QPP is the umbrella term for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). MIPS and AAPMs make up a two-track system that replaces Medicare’s traditional fee-for-service payment model. QPP changes the way physicians are paid and rewards for the quality of care delivered to patients, not the quantity.

Bookmark the MACRA Resources page »


What is the Physician Quality Reporting System (PQRS)?

  • Pay-for-reporting, not pay-for-performance
  • Multiple ways to participate/report
  • Registry participation is the most promising path for small- and medium-sized practices
  • PQRS is not a substitute for local quality improvement efforts
  • Penalties began in 2015 and will continue through 2018 for those who did not successfully report two years earlier (e.g. -2.0% in 2017 and 2018 if no successful reporting in 2015 and 2016, respectively).
  • PQRS outcomes are partially used to calculate the value-based payment modifier
  • In 2019 and beyond, PQRS will be replaced by the merit-based incentive payment system (MIPS)

PQRS Reporting Options

Individual eligible professionals (EPs) may report information on individual PQRS quality measures or group measures using the following mechanisms: 

  • Medicare Part B claims-based reporting (CPT II or G codes)
  • Certified electronic health record technology (CEHRT) product
  • CEHRT via data submission vendor
  • Qualified clinical data registry (QCDR)

Group practices should register to report as a group. EPs within a group must report as individuals if the practice did not register. Group practices may report PQRS quality measures using the following mechanisms: 

  • Web interface (for groups of 25+ EPs only)
  • Certified electronic health record technology (CEHRT) product
  • CEHRT via data submission vendor
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS via CMS-certified survey vendor (for group practices of 2+ EPs) to supplement PQRS group practice reporting

Qualified Registries

A list of CMS qualified registries(www.cms.gov) is available on the CMS web site.

The American Medical Association also maintains an inventory of national clinical registries(www.abms.org).