Are you Eligible to Participate in PQRS?


CMS Physician Quality Reporting System (PQRS) program encourages the reporting of quality information through incentive payments (through 2014) and payment adjustments (beginning in 2015). PQRS provides an incentive payment to practices with eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services. EPs who do not satisfactorily report data on quality measures in 2013 will be subject to a payment adjustment in 2015. The first step to participate in the PQRS program is to determine if you are eligible to participate.

Are you an eligible professional?

PQRS EPs provide services which are paid under or are based on the Medicare Physician Fee Schedule (PFS); those services are eligible for PQRS incentive payments for satisfactory 2013 participation.

Are you eligible, but not able to participate? Due to some billing methods, not every professional on the list of eligible physicians, practitioners, and therapists is able to participate in PQRS. You may not be able to participate in PQRS if any of these scenarios apply to you:

• You provide Part B services, but bill Medicare at a facility or institutional (Part A) level.
• You do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services.
• You reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing.

Are you eligible, but not sure how to get started? Once you have determined that you are eligible and able to participate in PQRS, you should meet with your staff to determine which PQRS reporting method is most appropriate for your practice. Visit the How to Get Started page on the PQRS website for step-by-step instructions on how to participate.

Additional questions? The QualityNet Help Desk is available Monday through Friday from 7am until 7pm CT to answer your questions about PQRS. Contact the Help Desk by calling 866-288-8912 (TTY: 877-715-6222) or emailing

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