Providers considered eligible and able to participate in the Physician Quality Reporting System (PQRS) may be subject to payment adjustments beginning in 2015. Eligible professionals (EPs) and group practices that fail to satisfactorily report data on quality measures during the 2013 program year will be subject to a 1.5% payment adjustment of their Physician Fee Schedule (PFS) charges beginning in 2015.
Individuals and group practices participating in PQRS must meet one of the following criteria to avoid payment adjustments in 2015.
Criteria for Individual EPs
EPs can avoid the 2015 payment adjustment if one of the following criteria is met during the 2013 PQRS program year:
1. Meet the requirements outlined in the 2013 PQRS measure specifications* (this will enable the EP to earn a 2013 PQRS incentive payment of 0.5% of their covered Medicare Part B charges)
2. Report at least:
One valid measure via claims, participating registry, or through a qualified Electronic Health Record (EHR) OR
One valid measures group via claims or participating registry
3. Elected to participate in the administrative claims-based reporting mechanism October 18, 2013
Criteria for Registered Groups (ACO/PQRS GPRO)
Group practices participating in the Group Practice Reporting Option (GPRO) can avoid 2015 payment adjustments if one of the following criteria is met during the 2013 PQRS program year:
1. Group meets the following requirements, outlined in the 2013 PQRS GPRO Fact Sheet
Report specific ACO/GPRO measures through the Web Interface OR
Report at least 3 registry measures (for 80% of the group’s eligible patients for each measure) for the GPRO outlined in the 2013 PQRS Measure Specification for Claims/Registry Reporting of Individual Measures
2. Report at least one valid measure through the Web Interface OR participating registry
3. Elected to participate as a GPRO in the administrative claims-based reporting mechanism by October 18, 2013
Note: Administrative claims-based reporting is not available to ACO GPROs
View the PQRS Payment Adjustments Tip Sheet for more information on how to avoid the 2015 payment adjustment.
For more information or support on the PQRS program, please visit the PQRS Incentive Program website or the Help Desk.
*Note: The asterisk indicates resources are in a zip file.