Physician Quality Reporting System (PQRS)

PQRS is a federal quality reporting program that requires physicians and non-physician practitioners to report quality information for covered Physician Fee Schedule services as furnished to Medicare Part B Fee-for-Service beneficiaries. The program will sunset after the 2018 payment adjustment year and be replaced by the new Merit-Based Incentive Payment System (MIPS), which is a consolidated quality reporting program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For more information about MIPS, visit MGMA's MACRA Resource Center.

In 2018, PQRS-eligible professionals will be subject to a 2% penalty for unsatisfactory reporting or non-participation in the 2016 PQRS reporting period. 

2018 Medicare payments based on 2016 PQRS reporting will be further impacted by the value-based payment modifier. Visit MGMA's Value-Based Payment Modifier Resource Center to learn more about this separate program and how it interacts with PQRS.

Feedback and Appeals

On Sept. 26, 2016, CMS released the 2015 PQRS Feedback Reports, which display information about whether a group practice or individual eligible professional met the reporting criteria in calendar year 2015 and whether the group or clinician will be subject to a 2% penalty, which will apply to items and services billed during calendar year 2017. Review MGMA's "What Practice Leaders Need to Know: Medicare Quality and Cost Feedback" to learn more about how to access and utilize your group's feedback reports.

MGMA Resources:

 

Latest news on PQRS:


For more news on PQRS and other healthcare issues, visit the MGMA Washington Connection archive.

MGMA Advocacy:

  • MGMA calls for exemptions to pre-MIPS quality reporting program penalties
  • MGMA letter to CMS: extend 2017 PQRS informal review deadline and allow for manual review of erroneous automatic denials
  • MGMA submits formal comments in response to the release of the Proposed 2017 Medicare Physician Fee Schedule


To see all of MGMA's advocacy efforts, visit the Advocacy Archive.
 

CMS Resources:

 

 

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