CMS PQRS Reporting: An Overview and Recent Changes


PQRS stands for Physician Quality Reporting System, earlier known as PQRI. It was established in 2007. It’s voluntary in years 2007 through 2014 and they’re trying to use the caret in terms of giving a bonus in those years. And then the stick will come in 2015 where there will be a penalty if you don’t use CMS PQRS and report the measures.

So in the caret mode, they gave us 2% up to 2010. We’ve got a 1% bonus. It’s now declined. And then we had a 5% bonus in 2012 through 2014. So when we  talk about 1% and .5%, what does that mean? That means that 1% of your total Medicare allowed amount. So whatever your total Medicare allowances are, it would be 5%  of that in 2012 through 2014.

So those penalties begin in 2015 for those who do not satisfactorily report data on quality PQRS measures and it will be reducing your Medicare charges payments of 1.5% in 2015 and 2% in 2016 and thereafter there’s going to be proposal amounts.

So, we’ve got a problem where our Medicare schedule is falling every year or hopefully stable. But even stable, we’re losing money because our cost of delivering services is going up. And if we don’t meet the PQRS requirements in 2015 and after, they’re going to be taking away from our Medicare fee schedule. So they’re going to take the Medicare fee schedule. They’re going to be reducing it by 2%.

So whatever your Medicare fee is, let's say it's $100 for this x procedure, they're going to pay you $98. So they're going to be reducing your Medicare fee schedule and it's going to be hard to afford that. And then if you're not doing electronic prescribing you're going to have penalties for that. So we have penalties for PQRS as per Medicare guidelines. We have penalties for e-scribing.

Right now, we have the caret for EHR. We may have the stick for EHR. So we're going to be losing all over the place if we don't provide all this technology and reporting for Medicare. So yes, we have the carets now but we have the sticks later.

Eligible professionals for reporting PQRS

There are quite a few different eligible professionals as per healthcare guidelines. So it's not just physicians. It's also optometrist. It's oral surgeons. It's dentists. It's chiropractors. It's PAs and nurse practitioners. It's anesthesiologists. It's social workers. It's psychologists, dieticians, nutritionists, audiologists, physical therapists, occupational therapists, et cetera. So the key is not only about the bonuses now but the question is, are they going to be eligible professionals for the penalties later.

Learn more about major changes and required documentation in the CMS PQRS program with a wide range of quality audio conferences at AudioEducator.