Physician Quality Measure Reporting (PQRS)

    What is PQRS?

    The Centers for Medicare and Medicaid (CMS) developed several initiatives with the intent of decreasing costs while improving healthcare quality and delivery. PQRS is one of these initiatives and is currently being implemented according to federal mandates.  PQRS provides a financial incentive to eligible professionals (EPs) who satisfactorily report information on specified quality measures for covered professional services provided under the Medicare Physician Fee Schedule.  EPs include all Medicare physicians and most other healthcare practitioners and therapists.  At this time, PQRS is incentive based but as of 2015, the program will administer reimbursement penalties to EPs who do not satisfactorily report information on quality measures.  It is important to note that 2015 penalties will be based on 2013 performance and providers who choose not to participate or who don’t satisfactorily report information on the specified quality measures will receive a 1.5 percent penalty in 2015 and a 2 percent penalty thereafter

    Click here to download an expanded description of PQRS and the Value Modifier.

    Click here to view 2014 Final Rules for PQRS.

    PQRS Incentives and Penalties


    % of total estimated Medicare Part B Physician Fee Schedule allowed charges for covered professional services










    How do I register for PQRS in order to receive the incentive?  

    There is no need to sign-up for PQRS as EPs will be identified by their National Provider Identifier (NPI) and Tax Identification Number (TIN).  In order to receive the incentive payment, EPs must report data on specified quality measures for a particular reporting period and these measures may change from year to year.  Requirements to qualify for an incentive differ from those required to avoid penalties however, qualifying for the incentive avoids the payment penalty.

    What are the methods for reporting the specified quality measures?

    An EP can choose to submit data to CMS via a variety of reporting methods.  Each method has specific criteria for reporting information to CMS:

    1) Medicare Part B Claims reporting: providers must add CPT II or G codes at the time of billing
    2) Qualified Physician Reporting Registry: providers must select a CMS approved registry which collates data and calculates the measures
    3) Qualified Electronic Health Record (EHR): The EHR must be certified by CMS to accept PQRS
    4) Administrative Claims reporting: CMS calculates billing claims against pre-determined quality measures
    5) Group Practice Reporting (GPRO): A practice must be accepted by CMS directly for participation

    How do you report as an individual versus as a group practice?

    Providers may report as individuals using Medicare Part B Claims, a Qualified Physician Reporting Registry, an EHR, using individual measures or measures group reporting (see next question) in order to avoid the 2015 penalties.  In order to receive the incentive, individual providers must adequately report using Medicare Part B Claims, a Qualified Physician Reporting Registry or an EHR.  (Reporting individual or group measures only avoids the penalty). 

    The reporting requirements for group practices depend on the size of the group:

    • 2-24 providers: Qualified Physician Reporting Registry, EHR, administrative claims reporting, or individual measure reporting 
    • 25-99 providers: Qualified Physician Reporting Registry, EHR, administrative claims reporting, individual measure reporting, or GPRO
    • ≥100 providers: same reporting options as the 25-99 provider group but subject to the value-based modifier (see next section)  

    *administrative claims reporting and individual measure reporting only avoid the penalty they do not allow the group to qualify for the incentive payment.

    What are the reporting options?

    1) Individual Measures-provides an indication of performance related to a specific outcome.  There are more than 300 individual measures to choose from and EPs who choose this reporting option must select at least three.  Examples of individual measures include: perioperative temperature management, screening for unhealthy alcohol use and documentation of current medication in the medical record.
    2) Measures Groups-groups of 4 or more measures related to a clinically similar condition.  EPs who choose to report based on a group measure must select at least one.  As of 2013, there are 22 measures including: Perioperative Care, Diabetes Mellitus and Hypertension.

    EPs may participate in PQRS as an individual or as part of a group practice.  Requirements for reporting depend on the method of reporting, the reporting option selected and the size of the group. 

    To get started, consult the CMS website for official details and expectations:


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