Not Too Late

Message from CMS Regarding 2012 PQRS Reporting

The following is a letter circulated by CMS about the PQRS program reminding physicians that “it is not too late” to participate for 2012:

It is not too late to start participating in the 2012 Physician Quality Reporting System (PQRS) and potentially qualify to receive an incentive payment equal to 0.5% of an eligible professional’s total Medicare Part B allowed charges for services furnished during the reporting period. A new six-month reporting period using the registry submission option began on July 1, 2012. In addition, there are still ways to participate in the 12-month reporting period using claims, registry, or EHR submission.

The 2012 PQRS has two reporting periods: 12 months (January 1–December 31, 2012) and 6 months (July 1–December 31, 2012).

You can use one of the following options to report PQRS data for services furnished January 1–December 31, 2012:

  • EHR-based reporting (Direct EHR or Data Submission Vendor) of at least three PQRS measures for 80% or more of the applicable Medicare Part B FFs patients
  • EHR-based reporting (Alignment with Medicare EHR Incentive Program) of all three Medicare EHR Incentive Program core measures OR up to three Medicare EHR Incentive Program alternate core measures AND three additional measures for the Medicare EHR Incentive Program
  • Registry-based reporting of at least three PQRS measures for 80% or more of the applicable Medicare Part B FFS patients
  • Registry-based reporting of at least one measures group for 30 or more applicable Medicare Part B FFS patients
  • Registry-based reporting of at least one measures group for 80% or more of applicable Medicare Part B FFS patients (with a minimum of 15 patients)
  • Claims-based reporting of at least one measures group for 30 or more applicable Medicare Part B FFS patients

To report PQRS data for services furnished July 1–December 31, 2012, use the following option:

  • Registry-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients (with a minimum of eight patients)

Eligible professionals do not need to sign up or pre-register to participate in the 2012 PQRS. Submission of the appropriate quality data codes (QDCs) for individual PQRS measures or for a measures group to CMS on Part B claims will indicate intent to participate. Eligible professionals who intend to participate via registry or EHR mechanisms should work with their registry or EHR vendor on transmitting their 2012 PQRS measure data to CMS in early 2013.

Although there is no requirement to register prior to submitting the data, there are some preparatory steps that eligible professionals should take prior to undertaking PQRS reporting. CMS has created many educational products that provide information about how to get started with PQRS reporting. To access all available educational resources on PQRS, please visit the CMS website. Eligible professionals are encouraged to visit the PQRS webpage often for the latest information and downloads on PQRS.

Eligible professionals also should note that 2012 is the last reporting year tied exclusively to an incentive payment. Beginning in 2015, CMS will apply a negative payment adjustment to eligible professionals who do not satisfactorily report data on quality measures for covered professional services. Reporting during the 2013 PQRS program year will be used to determine whether a PQRS payment adjustment applies in 2015. The proposed criteria for satisfactorily reporting data on quality measures to avoid the 2015 PQRS payment adjustment is detailed in the 2013 Medicare Physician Fee Schedule Proposed Rule, which was published on July 30, 2012. A link to the proposed rule is provided in the resources section below.

Resources:
•    2012 PQRS Implementation Guide and Measures List
•    Phase 2 Qualified Registries for 2012 PQRS Reporting
•    Final Qualified EHR Direct Vendors for 2012 PQRS Reporting
•    Final Qualified EHR Data Submission Vendors for 2012 PQRS Reporting
•    2013 Medicare Physician Fee Schedule Proposed Rule

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