Physician Quality Reporting System (PQRS)

Lately, we've been asked a lot about the PQRS and how it applies to insurance billing. Today, we'll dive into the basics of PQRS, and why it's important for dietitians to participate. 

PQRS stands for Physician Quality Reporting System. It's a reporting program for eligible professional (EP) and group practices who wish to asses and report their quality of care to Medicare. PQRS falls under Medicare Part B. 

GPRO is the Group Practice Reporting Option. A group practice under PQRS has one TIN (Tax Identification Number) with 2 or more individual EPs who reassign billing rights to the TIN. Unlike single EPs, GRPO must register in order to participate. Registration can be accessed through the Physician Value- Physician Quality Reporting System at the CMS Enterprise Portal.  

Who is an Eligible Professional?  

Any Medicare physician, practitioner, or therapist who provides covered professional services that are paid under the Medicare Physician Fee Schedule. Registered dietitians and nutrition professionals are included in this.

Why Should I Participate? 

  1. Reporting your quality of care ensures you give your patients the best care possible!
  2. Avoid negative payment adjustments- if you fail to satisfactorily report on PQRS quality measures, you'll face a negative payment adjustment in 2018.

The Negative Payment Adjustment

Starting in 2016, the negative payment adjustment has been changed to 2%. This means that the EPs and participating groups who do not satisfactorily report their information, will receive only 98% of their allowed Medicare Part B Physician Fee Schedule amount for covered professional services.  

How Can I Report my Information? 

Individual EPs can report their information on any of the following: 

  1. Medicare Part B Claims
  2. Qualified PQRS Registry 
  3. Direct Electronic Health Record (EHR) 
  4. Certified Electronic Health Record Technology through a data submission vendor 
  5. Qualified Clinical Data Registry

Participating Groups can report their information on any of the following: 

  1. Qualified PQRS registry 
  2. Web Interface for groups bigger than 25 
  3. Direct Electronic Health Records (using certified electronic health record technology)
  4. Certified Electronic Health Record Technology through a data submission vendor
  5. Consumer Assessment of Healthcare Providers and Systems for PQRS through a CMS- certified survey vendor. This is only for group practices greater than 2. 

For more information visit the PQRS page on the CMS website.