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PQRS administrative claims-based reporting deadline is October 15



September 20, 2013
Area(s) of Interest: Electronic Health Records Health Information Technology Practice Management 

Physicians who do not successfully participate in the Physician Quality Reporting System (PQRS) this year will be subject to PQRS payment penalties starting in 2015.


PQRS is a Centers for Medicare and Medicaid Services (CMS) quality reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals.


Physicians who do not report on at least one individual measure in 2013 or elect to participate in the administrative claims reporting option will receive a 1.5 percent payment penalty in 2015. The penalty goes up to 2 percent in 2016 and beyond.


Physicians who successfully report on three individual measures or one measures group will receive a 0.5 percent bonus. Physicians participating in a maintenance-of-certification program are eligible for an extra 0.5 percent bonus, for a total bonus of 1 percent.


There are several methods of reporting data: claims-based reporting; registry-based reporting; qualified EHR reporting; and group practice reporting. For more details on each of these methods, see the California Medical Association (CMA) guide, " Getting Started with the Medicare Physician Quality Reporting System," available free to members in the CMA resource library.


In 2013 only, CMS has made available the "administrative claims-based reporting mechanism" as an alternative method of avoiding the payment penalty in 2015. Physicians who cannot or choose not to use one of the reporting methods listed above, can sign up for an exemption via the administrative claims-based reporting mechanism before October 15, 2013.


Providers who choose the administrative claims-based reporting will be automatically evaluated from claims data on 19 quality measures for 100 percent of their applicable Medicare Part B fee-for-service beneficiaries to whom the measure applies.


Physicians must sign-up for this exemption on the CMS Enterprise Portal. The registration site will be available until October 15, 2013.


For more information, see CMS's fact sheet, "2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment," which provides additional information on physicians' options for avoiding the payment adjustments in 2015.


Contact: Michele Kelly, (213) 226-0338 or mkelly@cmadocs.org.

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