Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI) is a program by the Centers for Medicare & Medicaid Services (CMS). PQRS uses downward payment adjustments (penalties) to promote reporting of quality information by eligible professionals. Those eligible professionals who do not satisfactorily report (or do not report) data on quality measures for Medicare Part B services paid under the physician fee schedule will incur a two percent penalty on their Medicare Part B payments. The 2016 PQRS payment adjustment will be assessed using data reported during calendar year 2014, and the data collected for reporting year 2016 will be used for the 2018 payment adjustment.
2016 is the last year of the PQRS program. Beginning in 2017, urologists will need to follow the reporting requirements for the Merit-Based Incentive Payment System (MIPS) or participate in an advanced alternative payment model (APM).
2016 PQRS Information (via CMS)
2016 PQRS Update [YouTube]
CMS webinar explains the changes for the 2016 PQRS reporting program
2016 PQRS Implementation Guide [pdf]
This comprehensive guide is designed to assist PQRS users of all levels with 2016 reporting
2016 Beginner Reporter Toolkit
Walks you through the process to begin PQRS reporting for the first time
2016 How to Report Once for Medicare Quality Programs [pdf]
Helps determine how reporting once can satisfy both PQRS and Meaningful Use program requirements
PQRS Frequently Asked Questions (FAQs) compiled by CMS
Learn from the questions posed to CMS by other PQRS participants
2016 Claims Reporting Made Simple [pdf]
Walks first-time participants through the basics of reporting through your Medicare claims.
2016 Claims-Based Coding and Reporting Principles [pdf]
CMS explains how to properly code the 1500 form for PQRS reporting
2016 Registry Reporting Made Simple [pdf]
Introductory material walks first-time participants through the basics of using a qualified (or traditional) registry for PQRS reporting.
2016 PQRS Qualified Registry Training Guide [pdf]
User guide is designed for those who might have used a qualified registry before and have some advanced questions.
Electronic Health Record (EHR) Reporting
2016 Reporting Using an Electronic Health Record (EHR) Made Simple [pdf] –
Introductory material explains the basics of using one's EHR system to report for PQRS.
Qualified Clinical Data Registry (QCDR) Reporting
2016 Qualified Clinical Data Registry (QCDR) Participation Made Simple [pdf]
QCDR reporting is CMS's newest form of PQRS reporting, and this material explains the process for first-time users.
AUA Qualified Registry
Registry service to report your PQRS data to CMS.
Measure-Applicability Validation (MAV) Process
For those unable to report the required nine PQRS measures (covering at least three domains of care), the Measure-Applicability Validation process is applied. Through the MAV process, CMS determines whether individual eligible professionals (EPs) or group practices have satisfactorily participated in PQRS to the best of their ability. CMS provides an explanation of their process for claims reporting and qualified (traditional) registry reporting [pdf].
Value-Based Payment Modifier
The Value Based Payment Modifier (VM) is a quality program, affecting all providers, that is based on cost and quality. The VM program utilizes reported PQRS data along with other information collected and assessed by CMS to either reward or penalize physicians for the quality and cost of care provided.
The non-PQRS quality measurement component of the VM includes three outcome measures that CMS calculates from fee-for-service Medicare claims:
- Two composite measures of hospital admissions for ambulatory care-sensitive conditions
- Acute conditions
- Chronic conditions
- One measure of 30-day all-cause hospital readmissions.
2018 Value-Based Payment Modifier (VM) Policies [YouTube]
Webinar that explains the tenets of the VM program for the 2016 reporting year. The payment/penalty will be implemented in 2018.
Fact Sheet for the 2016 Value-Based Payment Modifier[pdf]
Provides an overview of how the 2016 Value-Based Payment Modifier will be calculated.
Fact Sheet for Attribution in the Value-Based Payment Modifier Program [pdf]
Provides an overview of how patients will be attributed to providers through the 2016 Value-Based Payment Modifier.
Fact Sheet for Specialty Adjustment in the Value-Based Payment Modifier Program [pdf]
Provides an overview of the specialty adjustment methodology implemented in the Value-Based Payment Modifier Program.
More information on the VM program is available on the CMS website.