Sunday, August 26, 2012

How much incentive payment for PQRS program

How much is the payment?


A participating individual eligible professional or group practice who satisfactorily reports data on
Physician Quality Reporting System quality measures may earn an incentive payment equal to the
applicable quality percent of the Secretary of the Department of Health and Human Services’ (HHS)
estimate of allowed part B charges for covered professional services furnished by the eligible
professional or group practice during a specified reporting period.


The applicable quality percentages for years 2007-2014 are displayed in the following table:
2007 and 2008 1.5%
2009 and 2010 2.0%
2011                1.0%
2012-- 2014    0.5%


In addition, from 2011 through 2014, participating eligible physicians may qualify to earn an additional
Maintenance of Certification Program incentive (the applicable quality percent for each year is 0.5%).
To earn this additional incentive payment, each year, the physician must:

1. Satisfactorily submit data on quality measures (i.e. meet the criteria for satisfactory reporting
to earn a Physician Quality Reporting System reporting incentive) for the 12-month reporting
that applies for the year;

2. Have such data submitted on their behalf through a Maintenance of Certification Program that
meets the criteria for registry (as specified by CMS) or an alternative form and manner that
the Secretary determines is appropriate;

3. Participate in a Maintenance of Certification Program more frequently than is required to
qualify for or maintain board certification status; and

4. Successfully complete a qualified Maintenance of Certification Program practice assessment
more frequently than is required to qualify for or maintain Board certification status.

What is measured?


For 2012, CMS retained all of the 2011 Physician Quality Reporting System measures groups; and
added 8 new measures groups, for a total of 22 measures groups. In addition, 15 specific conditions
contained in these measures groups are also reportable as individual measures.


You can find the complete list of the individual Physician Quality Reporting System quality measures
for a specific program year, along with  the associated detailed measure specifications and respective
reporting requirements, at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/index.html on the CMS website. Additionally, measures group specifications for the current or upcoming program year can be found on the Measures Codes page of the same
website








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