Physician Quality Reporting

While many loathe and some laud Medicare’s efforts to collect data from physicians in attempt to measure quality, it's safe to say that quality reporting programs are here to stay and will continue to expand over time.

Many physician practices and medical clinics have been too overwhelmed with other administrative matters to even consider thinking about quality reporting. However, if you or your practice provides care to Medicare patients, then quality reporting is a topic you need to strongly consider participating in this year and going forward.

Incentives Are Moving to Penalties

For physicians, quality reporting was first introduced by the Centers for Medicare & Medicaid Services (CMS) in 2007. Since then, the program has evolved and is now known as the Physician Quality Reporting System (PQRS) program.

For the first seven years of the program, physicians had the opportunity to earn incentive payments. In 2007 the incentives were 1.5% of all Medicare billings and in the final year of incentives, 2014, incentives were 0.5% of Medicare billings.

Starting in 2015, physicians that did not participate in the PQRS data reporting program back in 2013 received a 1.5% penalty. And in 2016, physicians that did not participate in 2014 will experience a 2.0% penalty. 

For some physicians and practices, especially those with a significant volume of Medicare billings, a penalty of 1.5% or 2.0% could impose financial hardship.

Have you already received a penalty for not participating in the PQRS program? If you have, and would like help avoiding penalties in future years, contact us.

Calculating Potential Penalties

There are several factors that go into calculating you or your practice’s PQRS penalties for non-participation. We have staff that, for no charge, will meet with you to help you calculate your penalties. Please contact us to set up a time for us to help you.

New Legislation Does Not Immediately Replace PQRS

In April of 2015, congress passed, and the president signed, the Medicare Access and CHIP Reauthorization Act (MACRA) – which is also known informally as the "SGR repeal law." The MACRA bill phases out physician payment incentives under the Meaningful Use program and those under the PQRS program, eventually replacing the incentives in those programs with a new program called the Merit-based Incentive Payment Program, or MIPS. Physicians will also be able to opt for an alternative program involving slightly higher payments in return for participation in certain Alternative Payment Models, or APMs.

Despite the passing of the MACRA bill, through the end of 2018 providers will continue to be subject to the penalties associated with the Physician Quality Reporting System (PQRS), the meaningful use program, and the physician value-based purchasing program.

Reporting Penalties Add Up for Non-Participation in Quality Reporting and Meaningful Use (MU) Programs:

Confused or Overwhelmed?

If you would like assistance, please contact us or learn more about how we can help you navigate the quality reporting maze.