Freed Associates

Adjust Your PQRS Reporting Mechanism

TOPIC: Medicare

All physicians who bill to Medicare will incur an automatic 1.5% penalty on all Medicare reimbursements in 2015 if they do not sign up to submit clinical quality measures (CQM) through the Physician Quality Reporting System (PQRS) by October 15, 2013. The penalty increases to 2.0% in subsequent years.

Further, in 2015, CMS will begin applying a “value-based modifier” (VBM) to the clinical quality measures (CQMs) for physician groups of 100+, which will result in an automatic 1.0% penalty on all Medicare reimbursements if groups have not chosen a VBM quality reporting mechanism through PQRS. This penalty also increases to 2.0% in subsequent years and additional physician groups and individuals that bill Medicare will be included.

Eligible providers who do not register in PQRS will automatically have a PQRS penalty of -1.5% applied to their 2015 Medicare payments. Additionally, eligible groups of 100+ physicians who do not choose a VBM calculation method will automatically have a VBM of -1.0% applied to their 2015 Medicare payments:

  • Eligible provider groups of 100+ who are already submitting CQMs to PQRS must also choose their method of VBM calculation
  • Eligible providers who are not submitting to PQRS must sign up for PQRS. They may choose to sign up through the VBM portal in PQRS and then choose to have CMS calculate their CQMs

Simplest choice is for groups or individual physicians to sign up for the “CMS Claims-based Calculation.”

For more information, visit CMS website