PQRS – How to skip participation (almost) and NOT get penalized

At the time of this posting you have three options left for PQRS participation in order to avoid the mandatory 1.5% Medicare payment reduction that will be PQRS2applied in 2015 for eligible professionals who do not participate in 2013. These options are:

  • You can participate in the 6 month reporting period from July 1, 2013 to Dec 31, 2013 via a third party Registry-based reporting option of a Measures Group (there may be costs incurred with this option)
  • G-code submission on Medicare billing.  It has been reported by the American Medical News that CMS has lowered reporting thresholds thus increasing ways to prevent the 2015 penalty. CMS will deem the submission of at least one quality measure, in the form of a G-code, during an applicable 2013 patient encounter as being satisfactory to avoid the 2015 payment adjustment. Submission of the G-code must follow the rules for reporting the PQRS measure, so it must be associated with a service provided during an eligible patient encounter that fits the correct diagnosis codes and criteria for the measure denominator.

Or what is probably the easiest way, the “(almost)” option – 


During the self-nomination/registration period (July-October 15, 2013) groups of any size, as well as individual eligible professionals can request that CMS calculate their quality performance based on administrative claims.  The CMS-calculated administrative claims reporting option requires no effort beyond signing up. Large groups (with 100 or more eligible professionals billing under a single TIN) can avoid both a negative 1% value modifier fee adjustment and avoid a negative  1 .5% PQRS payment adjustment in 2015. For small groups and individuals, signing up for the CMS-calculated administrative claims reporting  option will also avoid a negative payment adjustment in 2015 that would be imposed for not participating in PQRS. In 2013, neither individuals nor groups of fewer than 100 eligible professionals are subject to the value modifier. Small groups and eligible professionals choosing the CMS-calculated administrative claims reporting option would use the same July-October 2013 self-nomination process as large groups. Please note, groups and individuals who sign up for the CMS-calculated administrative claims reporting option will not earn a PQRS incentive payment. (taken from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/News.html)


Here is the link to the Physician and Other Health Care Professionals Quality Reporting Portal.


For more information – http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRI


Background on PQRS – http://medicalsoftwaresolutions.net/physician-quality-reporting-system/




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