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Explore the basics on some of the Federal quality reporting programs. For more information or questions, please contact ACR staff at
PQRS is a quality reporting program that rewards eligible professionals (EPs) for satisfactorily reporting data on quality measures for services furnished to Medicare Part B beneficiaries.
How to avoid the payment adjustment by using RISE:
How to avoid the payment adjustment by using the RCR:
View the PQRS Timeline 2015-2017
For the 2016 program year, providers must demonstrate meaningful use of Electronic Health Record (EHR) systems by meeting specific criteria. All providers are required to attest to a single set of objectives and measures. This replaces the previous structure of previous stages that required attestation to a core and menu set of objectives.
Eligible professionals report the following ten objectives:
The EHR reporting period must be completed within January 1 – December 31 of the 2016 calendar year. For all returning participants, the reporting period will be the full calendar year from January 1, 2016 - December 31, 2016. For eligible professionals who have not successfully demonstrated meaningful use in a prior year, the reporting period will be any continuous 90-day period.
All providers must attest to objectives and measures using EHR technology certified to the 2014 Edition. All providers may attest to objectives and measures using EHR technology certified to the 2015 Edition, or a combination of the two (if the 2015 Edition is available).
The Value Based Modifier (VBM) program provides comparative performance information to physicians to help improve the quality of medical care. Physicians are paid based on the quality of care furnished compared to the cost of care. The VBM is being phased in slowly and will affect all physicians beginning in 2017 based on 2015 performance. The VBM’s quality measurement component is aligned with the reporting requirements under PQRS.
Learn more about the value-based modifier on the CMS website.
Contact CMS QualityNet Help Desk at 1-866-288-8912 or firstname.lastname@example.org.
Keep in mind that, beginning in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) will be in effect. The MACRA will combine existing quality reporting programs into one new system and allow providers to choose from two payment paths, including the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
MIPS is a new program that combines the Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value Based Modifier (VBM) into one single program in which eligible professionals will be measured on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology.
APMs include payment models that incentivize providers on quality, outcomes, and cost containment. Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.