We have had a lot of calls lately asking us about PQRS. According to CMS.gov Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote the reporting of quality of treatment information by eligible professionals (EPs) to the Centers for Medicare & Medicaid Services (CMS).The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]).Several PQRS program changes were included in health care reform legislation enacted in 2010. The Affordable Care Act (ACA) requires the implementation of timely feedback and the establishment of an informal appeals process by 2011.

The ACA also calls for PQRS payment penalties starting in 2015. CMS finalized in its 2012 Medicare Physician Fee Schedule Rule that 2015 program penalties are based on 2013 performance. Therefore, those physicians who elect not to participate or are found unsuccessful during the 2013 program year, will receive a 1.5 percent payment penalty, and 2 percent thereafter. In the 2014 Medicare Physician Fee Schedule Rule, CMS finalized its proposal to base 2016 PQRS penalties off of 2014 reporting. Therefore, physicians who did not participate in PQRS in 2014 will receive a 2 percent penalty in 2016. 2014 was the last year a physician could receive an additional incentive for participating in the PQRS Maintenance of Certification (MOC) program or receive an incentive for participating in PQRS. In the 2015 Medicare Physician Fee Schedule Rule, CMS finalized its proposal to base 2017 PQRS penalties off of 2015 reporting.

Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This CMS website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS.

PQRS Payment Adjustments for EPs

Under Physician Quality Reporting System (PQRS), covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments. Click here for a complete list of all EPs that are affected by PQRS.

There are higher penalties for PQRS non-reporting – click here for payment adjustment information.

Beginning with the 2015 reporting period, failure to report, triggers 2 penalties: a PQRS non-reporting penalty of 2% plus a Value Based Payment Modifier (VBPM) non-reporting penalty ranging from 2 to 4%.

Time is Running Out for Mandatory E-Prescribing

The New York State Bureau of Narcotics Enforcement has finalized its guidelines for providers and pharmacies to implement the Internet System for Tracking Over-Prescribing (I-STOP). Effective March 27, 2015, New York providers will be required to comply with the mandate to e-prescribe. 

EPCS Gold 2.0 allows providers to safely prescribe legend and schedule II-V drugs electronically through the same workflow, further streamlining the prescription writing process.

EPCS Gold 2.0 builds on the current e-prescribing functionality within our QuicDoc Professional EMR Software and Enterprise Edition EHR Software, through our partnership with DrFirst. EPCS Gold is also available as a standalone product for our Office Therapy Practice Management Software users.

Please contact our Sales Department at 800-850-8510 for more information.

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