About PQRS

Physician Quality Reporting System (PQRS) is an incentive program from the Centers for Medicare and Medicaid Services (CMS), one that encourages physicians to report on the quality of their professional services as opposed to the quantity of their services. This is in an attempt to move medical professionals away from the Fee-For-Service payment structure, the traditional method of payment, toward a Pay-For-Performance (P4P) system.

What does this mean for your patients? The goal of this program is to emphasize the health in healthcare. Instead of always focusing on illness and symptoms, the goal is incentivize keeping healthy people healthier for longer. 

It's understandable that some practices would rather keep to the old Fee-For-Service payment structure. And why not? Why change something that looks like it works pretty well? Why break old habits? Well, according to the CMS website, "Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2013 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period."

If the benefits don't seem like enough of an incentive, there are future consequences for not changing to PQRS. According to the American Medical Association (AMA), in the year 2015, Eligible Professionals (EPs) who do not participate in PQRS and successfully report during the 2013 reporting period will be assessed a 1.5% reduction in all Medicare Fee-For-Service payments. This applies to Medicare Part B covered professional services furnished by the eligible professional during 2015 or any subsequent year.

In 2016, EPs who do not participate in PQRS and successfully report during the 2014 reporting period will be assessed a 2% reduction in all Medicare fee-for-service payments. This applies to Medicare Part B covered professional services furnished by the eligible professional during 2015 or any subsequent year.

Want to avoid these substantial losses? It's easy to start using PQRS. Just follow these simple steps and do it yourself in less than 5 minutes!

1. Go to Settings -> People and Places -> Payor.
2. Search under the Payor column for MED (Medicare).
3. Hit the Options 2 tab.
4. In edit mode, check the box that says Bill Zero Balance Charges.
5. Repeat for any other Medicare payors

6. For this step, you may want to contact Client Services for setup help: Go to Settings -> Procedures -> Procedure Maintenance and create a new entry using one of your PQRS measures with a zero dollar fee. (To get started with PQRS Measures, you can view the Implementation Guide on Medicare's Website.)

7.  When you enter Evaluation & Management charges for Medicare patients (such as 99213 for an office visit), enter an accompanying Measure (or Measures) using the appropriate PQRS procedure code(s) created in step 6.  Make sure the diagnosis codes, service date, provider, and location match the E&M code. Each eligible professional must satisfactorily report on at least 50 percent of eligible instances when reporting (through submitting claims) to qualify for the incentive.

There! You're all finished and you can start collecting those benefits in the years to come!

If you are already reporting some PQRS measures and have any thoughts or advice, please share your opinion below under "Post a Comment."

Contributors: Kylie McKenzie Soder and Christine Parker