2015 PQRS Feedback Reports and 2015 QRURs
The 2015 Physician Quality Reporting System (PQRS) feedback reports were released on September 26, 2016 for individual eligible professionals (EPs) and PQRS group practices. The PQRS feedback reports provide the determination on whether or not participants met the criteria for avoiding the 2017 PQRS negative payment adjustment. Detailed information about the quality data submitted by the provider is also included.
The 2015 PQRS feedback reports reflect data from Medicare claims received with dates of service from January 1, 2015 – December 31, 2015 that were processed into the National Claims History (NCH) by February 26, 2016. A PQRS feedback report is generated for each Taxpayer Identification Number/National Provider Identifier (TIN/NPI) combination that reported PQRS data or that submitted Medicare PFS claims that included denominator-eligible events but did not submit PQRS data. The feedback reports include all measures reported by the NPI for each submission mechanism used.
The 2015 Annual Quality and Resource Use Reports (QRURs) are also available for groups with 2 or more EPs and solo practitioners. Groups and solo practitioners are identified in the QRURs by their TIN. The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2015, and to those TINs consisting only of non-physician EPs.
The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. For physicians in groups with 2 or more EPs and physician solo practitioners that are subject to the 2017 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare PFS for physicians who bill under the TIN in 2017. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2017.
Authorized representatives of groups and solo practitioners can access the 2015 PQRS feedback reports and 2015 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access these reports, visit How to Obtain a QRUR.
Additional information about the 2015 Annual QRURs is available on the 2015 QRUR website and through the QRUR Help Desk at firstname.lastname@example.org or 888-734-6433 (select option 3). The informal review period ended December 7.
PQRS Measure Search Tool
CMS has a Physician Quality Reporting System (PQRS) online measure search tool located at https://pqrs.cms.gov/#/home and via the PQRS Measures Codes webpage. The tool helps identify claims and registry measures that may be applicable, and helps find measures that meet satisfactory reporting requirements for the 2016 PQRS program year. Users can click on a measure to view the individual claims and registry measure specifications for 2016. Users can also search measure-related keywords, as well as search and filter information such as:
- Measure Number
- Reporting Methods
- National Quality Strategy (NQS) Domain
- Cross-Cutting Measures
- Measure Steward
For further assistance or questions, contact the QualityNet Help Desk at 1-866-288-8912 or via email at email@example.com.
2016 PQRS Medicare Payment Reduction
The CMS final rule updating 2016 Medicare policies and rates changes several of the quality reporting initiatives, including PQRS. Major highlights include:
- Individual eligible professionals (EPs) and group practices that meet the criteria for 2016 PQRS satisfactory reporting/participation will avoid the PQRS negative payment adjustment in 2018
- PQRS group practices can participate in 2016 PQRS via the Qualified Clinical Data Registry mechanism in 2016
- There are 281 measures in the PQRS measure set and 18 measures in the group practice reporting option (GPRO) Web Interface for 2016
Please note that the 2018 PQRS payment adjustment is the last adjustment that will be issued under the PQRS.
The PQRS negative payment adjustment will end in 2019 and aspects of the program will be consolidated into the Merit-Based Incentive Payment System (MIPS) established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The APA website gives an overview of the PQRS along with an explanation of how to participate this year in order to avoid payment cuts in 2017. It also includes an example of claims-based reporting. Visit this page for PQRS details tailored to psychiatrists. For assistance, members can use the APA Helpline link on the same page [login required].