Steps to the Avoid the 2015 PQRS Negative Payment Adjustments for Individuals and Group Practices with 2-99 EPs

Physicians and other health care professionals who provide Medicare Part B Physician Fee Schedule (PFS) covered professional services need to be aware of a negative 1.5% payment adjustment under the Physician Quality Reporting System (PQRS) for individual eligible professionals (EPs) who do not submit data on PQRS quality measures to CMS in 2013. The payment adjustment will be implemented in CY 2015.

Individual eligible professionals (EPs) can submit data through the traditional PQRS methods (claims, registry and EHR) to avoid the 2015 payment adjustment and potentially earn a 2013 incentive payment of 0.5%. Alternatively, to avoid the payment adjustment only, EPs can request that CMS calculate their quality data from administrative claims. EPs must register for the CMS-calculated administrative claims option by October 15, 2013. To register for the CMS-calculated administrative claims option, EPs should use the instructions and information available in the Quick Reference Guide for Individual EPs.  http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PV-PQRS-EP-Registration-Quick-Guide.pdf

What Do Group Practices (with 2-99 EPs) Need To Do?

Group practices with 2-99 EPs can register to report under the PQRS Group Practice Reporting Option (GPRO) to avoid the 2015 PQRS payment adjustment and potentially earn a 2013 PQRS incentive payment of 0.5%. However, it is not required that they register under the GPRO if the preference is for each EP to report PQRS as an individual. Reporting options for group practices include the web-interface GPRO and registry. The reporting option available to the group will depend on the group size, so group practices should determine how many EPs they have billing Medicare under their tax identification number. Alternatively, to avoid payment adjustments only, groups can request that CMS calculate their quality data from administrative claims. Group practices must register and select their reporting method by October 15, 2013.

Please note: Groups with less than 100 EPs are not subject to the value modifier (VM) for 2015. To register as a group practice and select a reporting method, group practices should use the instructions and information available in the Quick Reference Guide for Group Practices. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PV-PQRS-Group-Registration-Quick-Guide.pdf

Additional information and resources are available at the PQRS website - http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html