What is PQRS and Why Should I Participate?

PQRS HISPQRS, or the Physician Quality Reporting System, is a program run by the Centers for Medicare and Medicaid Services (CMS) that is designed to promote the reporting of useful information via a series of incentives. 


Initially introduced as the Physician Quality Reporting Initiative, the PQRS is a federally mandated program focused on acquiring accurate information and drawing meaningful conclusions.  The specific requirements of the program change over time as legislation modifies the specifics based on previous year's results, but the CMS maintains a listing of currently applicable regulations that can be found here. Professionals who qualify under the current year's regulations are eligible to receive a payment for providing the information.  Physicians do not need to sign up in order to contribute information, but they must report (and meet current standards) in order to receive the 0.5% incentive payment.  Eligible professionals that do not satisfactorily report data on quality measures for the January 1, 2013-December 31, 2013 reporting period will be subject to a -1.5% adjustment in their fee schedule amount in 2015.  In total, this means a 2% difference in fees paid to a practice between full compliance with the PQRS program and non-compliance.

For the 2013 submission period, the PQRS program accepts a variety of information submission methods that physicians may choose from if they wish to participate and ensure that they are in full compliance with the PQRS regulations.  These methods are:

  • Direct reporting to the CMS on Medicare Part B claims

  • Sending data to a qualified Physician Quality Reporting registry

  • Use of an Electronic Health Record (EHR) to submit the data to the CMS electronically

  • Reporting to a licensed and qualified Physician Quality Reporting vendor

As the legislation for PQRS changes, some submission methods may be rendered obsolete or incompatible with current regulations. As a result of this, each practice participating in the program should review their submission method annually.  This will ensure that the method is still valid (or signal the need to change it) and prevent the loss of incentive payments that might otherwise occur.

Participation in the Program

There are two major reasons why qualifying practices should participate in the PQRS program.

The first major reason is the financial aspect of the program.  While the additional payments within the program are not large they are enough to cover expenses and provide each practice with a small improvement to their bottom line.  This has been made easier over time as companies have developed technology to work with CMS-approved registries and submit information quickly and easily. 

The second major reason that you should participate in the PQRS program is the humanitarian aspect.  Advancing technology and the ability to quickly and accurately report things has allowed the healthcare industry to process larger amounts of information than before.  This information can be used to create guidelines and regulations for physicians that can maximize the quality of care patients receive while still helping to promote the business aspects of healthcare.  In essence, participation in the program is something that will help patients down the line.  However, while large amounts of information can be processed, the results are only as accurate as the information on which they are based.  To properly identify trends, search tools need as much raw data as possible. This data can only be provided by qualifying practices, so the success of the program rests on the participation of those involved.

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