How to Get Started in PQRS

The CMS Physician Quality Reporting System (PQRS) program promotes the reporting of quality information using incentive payments, and payment adjustments beginning in 2015, to encourage eligible health care professionals (EPs) to report on specific quality measures. To help EPs get started with PQRS, CMS has outlined some basic steps for their participation.

Step 1: Determine Eligibility

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. Due to some billing methods, not every professional is able to participate in PQRS. View the complete list of EPs who may participate in PQRS.

Step 2: Choose Reporting Method

EPs can choose from several PQRS reporting options to submit their measure data. An individual EP may choose from the following methods to submit data to CMS:

• Registry reporting
• Claims reporting
• Qualified electronic health record (EHR) reporting
• Qualified PQRS EHR data submission vendor

Groups of two or more EPs can also report their data using the Group Practice Reporting Option (GPRO).

Step 3: Select Measures

EPs may choose at least three individual measures or one measures group as an option to report on measures to CMS. EPs should consider factors such as their quality improvement goals and the types of care they frequently deliver when selecting measures for reporting.

Step 4: Report Measures

The 2013 PQRS reporting year ends on December 31, and all reporting methods require quality data to be submitted by end of first quarter in 2014. EPs must correctly submit PQRS quality measures through one of the approved reporting mechanisms to receive a payment. EPs who use a registry or data submission vendor will need to work with their registry or vendor to ensure their data has been successfully submitted to CMS.

PQRS Resources

For more information about participating in PQRS, visit the PQRS website. For additional support or questions, contact the QualityNet Help Desk.

You can also learn about other eHealth initiatives at CMS by visiting the CMS eHealth website.

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.