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Some Will See Reduced Payment in 2015 Under PQRS

October 23, 2014:

Under the Physician Quality Reporting System (PQRS), eligible professionals (EPs) who did not satisfactorily report quality data to the Centers for Medicare and Medicaid Services (CMS) in 2013 will take a payment hit beginning in 2015.

The 1.5 percent downward payment adjustment in 2015 will apply to EPs’ covered Part B professional services under the Medicare physician fee schedule. In 2016 and beyond, the adjustment will be 2 percent.

PQRS has combined incentive payments and “payment adjustments” (reductions) to encourage providers to report measures of quality of care. The incentive payments began in 2007 at 2 percent of an EP’s estimated total allowed charges for covered services provided under the Medicare Part B physician fee schedule. In 2014, the last year such payments will be used under PQRS, the incentive payments were 0.5 percent of charges.

Although it is too late to head off the payment reduction in 2015, individual EPs wanting to avoid such reductions in 2016 and subsequent years can do one of the following for 2014 and beyond:

  • Satisfactorily report quality measures or participate in the PQRS program for incentive elegibility as defined in the 2014 PQRS measure specifications
  • Report at least three measures covering one national quality strategy (NQS) for at least half of the EP’s Part B FFS patients through claims or a qualified registry
  • Participate through a qualified clinical data registry (QCDR) that selects the measures to be submitted—at least three must cover a minimum of one NQS domain. The EP must also submit measures for at least half of his or her applicable patients seen during the relevant participation period.

Practices participating in the group practice reporting option (GPRO) can avoid payment reductions beginning in 2016 by doing one of the following in 2014 and subsequent years:

  • Satisfactorily report measures for incentive eligibility as defined in the 2014 PQRS measure specifications
  • Report at least three measures covering one NQS for at least half of the practice’s Part B FFS patients through a qualified registry.


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