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PQRS Incentive Program

PQRS is a quality reporting program that encourages individual eligible professionals (Eps) and roup practices to report information on the quality of care to Medicare. This is to ensure that patients are receiving the right care at the right time.

The Centers for Medicare and Medicaid Services (CMS) will provide physicians (who submit quality measures data for services provided) an incentive payment of 0.5% of their total allowed charges for 2012 through 2014. However, in 2015 the program becomes mandatory and can create penalties on those who do not successfully report their data to CMS. The penalty is 1.5% for 2015 and increases to 2.0% for 2016 and subsequent years.

What is the PQRS program?

The Physician Quality Reporting System, or PQRS (formerly known as PQRI), is a reporting program that provides a financial incentive payment to identified eligible professionals (EPs) who report data on quality measures for covered Physician Fee Schedule services furnished to Medicare Part B Fee-for-Service beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Medicare Part C–Medicare Advantage patients are unfortunately not included in claims-based reporting but may be included in registry-based reporting.

How to report to PQRS?

There different ways to submit for PQRS.

  • Registry Reporting
    • In this option, EPs will sign up with an approved CMS registry that will guide them thru the process starting with choose which measures to report for all the way to submitting the report and provides auditing help if necessary.
  • Electronic Health Record Reporting
    • EPs must have a IACS portal to be able to submit using EHR system
    • Report on at least 9 measures across at least 3 NQS domains
    • Use a direct HER product that is certified EHR Technology ( CEHRT) or HER data submission
  • Qualified Clinical Data Registry
    • This is different from a qualified registry in that it is not limited to measures within PQRS.
    • To be able to use this for reporting EPs must report at least 9 measures covering 3 NQS domains for at least 50% of the EP’s applicable patients seen during the 2015 participation periods.
    • And at least 2 outcome measures.
    • This has to be a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking.
  • Group Practice Reporting Option
    • Can use any option from above to report.

Who can participate in the program?

  • Physicians—MDs, DOs, Podiatrists, Optometrists, Oral Surgeons, Dentists, Chiropractors
  • Therapists—Physical Therapist, Occupational Therapist, Speech-Language Pathologist
  • Practitioners—Physician Assistants, Nurse Practitioners, Clinical Nurses, Specialists, 
Certified Registered Nurses, Anesthetists, Certified Nurse Midwives, Clinical Social Workers, Clinical Psychologists, Registered Dieticians, Nutrition Professionals, Audiologist FQHCs, Audiologist RHCs, Audiologist IDTFs, Audiologist ILs, and other providers that are not considered EPs.

Note: Practitioners are not defined as eligible professionals in the Tax Relief Health Care Act of 2006 or the Medicare Improvements for Patients and Providers Act of 2008 and do not qualify for an incentive. Additionally, these entities are paid under a different fee schedule.

How does WEBeDoctor help an EP with the PQRS program?With WEBeDoctor, a practice can easily capture all the necessary data to qualify for the CMS incentive without having to do any extra work on their end. The points accumulated during the exam are even displayed on the screen so providers can see the progress.PQRS offers an incentive for meeting documentation and reporting requirements, but with different measures applying to each practice, it can be time-consuming to administers. WEBeDoctor captures the necessary data easily with its free PQRS requirements plug in. Find out how physicians can modify rules and take advantage of automated reporting capabilities as well as convenient desktop control. Call WEBeDoctor today to learn how to participate in the PQRS program through the WEBeDoctor EMR software suite.

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