Physician Quality Reporting System (PQRS): Answers to Five of Your Most Pressing Questions

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    As you investigate options to fulfill public reporting requirements and avoid negative payment adjustments, no doubt you have discovered there are multiple mechanisms for reporting to the Physician Quality Reporting System (PQRS) and each has specific requirements.

    Following are the answers to some of your most frequently asked questions (FAQs) on the Physician Quality Reporting System (PQRS) received by ACG staff.

    PQRS FAQs

    1.  Do I have to register for PQRS by June 30, 2015?

    The answer is “it depends.” The June 30, 2015 deadline applies only if you and members of your group wish to collectively report to PQRS via the Group Practice Reporting Option (GPRO). This is the deadline to enroll in GPRO (or reverse your enrollment if this is not your desired reporting mechanism). Eligible providers in groups of 2 or more have various options for reporting to PQRS. Eligible providers in groups can also choose to report individually through other reporting options, such as claims or a qualified clinical data registry, and then be “grouped” at the TIN level for the purposes of the Value-Based Payment Modifier.

    If you are not planning to report via the Group Practice Reporting Option, CMS does not require you to register by June 30th for registry or claims reporting. The only registration required through CMS is if your group wishes to report via GPRO.

    And please note, once your group registers for GPRO, the providers in that group are not able to report individually. Therefore, if you wish to report via a qualified clinical data registry (QCDR), such as the GIQuIC QCDR, you must not be enrolled in GPRO/

     

    2.  Is a qualified PQRS registry and a qualified clinical data registry the same thing?

    No. There are two types of registries for reporting into PQRS. The requirements for each differ and there can be different options for reporting measures.

    A qualified PQRS registry facilitates individual provider and GPRO reporting using individual measures or measure groups.

    A qualified clinical data registry (QCDR) facilitates only individual provider reporting on PQRS measures, non PQRS measures approved by CMS, or a combination of those types of measures. CMS began deeming existing quality improvement registries as QCDRs for the purposes of PQRS reporting in 2014.

    To learn more about the GIQuIC registry and reporting to PQRS via the GIQuIC QCDR option, please visit the GIQuIC website and PQRS page.

    Contact GIQuIC with questions or to register.

    Email info@giquic.org

     

    3.  I am a solo practitioner. Do I need to participate in PQRS to avoid negative payment adjustments?

    Yes, solo practitioners who do not participate in PQRS 2015 reporting will receive a negative 2% payment adjust and will receive a further downward payment adjustment of another negative 2% as Non-PQRS reporters via the Value-Based Payment Modifier.

     

    4.  Can I report to PQRS and the ASC Quality Reporting Program all at once?

    No. PQRS is a provider-based reporting program whereas the ASC Quality Reporting Program and the Hospital Outpatient Reporting Program are facility-based reporting programs with separate requirements and reporting mechanisms.

     

    5.  I heard claims-based reporting is going away. Is that true?

    Claims-based reporting continues to remain one of the PQRS reporting options, although CMS does plan to phase out this reporting option in the future.

     

    Additional resources to assist you in navigating public reporting:

    ACG Medicare Reimbursement and Quality Reporting Toolkit

    Group Practice Reporting Option – CMS

    Physician Quality Reporting System (PQRS) Fact Sheet- CMS

    Brad Conway, ACG Vice President, Public Policy

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