How to Report PQRS to Avoid Penalties

Physician practices that don’t report PQRS in 2013 could automatically lose 2.5 percent of their Medicare reimbursement due to a two-fold penalty set to go into effect in 2015.

When Congress extended the PQRS bonuses through 2014, lawmakers also enacted provisions for PQRS penalties to begin in 2015. An adjustment of 1.5 percent will be imposed in 2015. In addition, the value-based payment modifier (VBPM) will begin to be applied to payments of PQRS non-reporters in 2015 or 2017, depending on practice size.

The Affordable Care Act requires Medicare to implement a VBPM that will affect your reimbursement based on the quality and cost of care provided to Medicare beneficiaries enrolled in the traditional fee-for-service program. Under the VBPM, practices that fail to report PQRS will automatically be assessed an additional 1 percent penalty.

Here’s how to avoid penalties:

  • To avoid the 1.5 percent PQRS penalty for 2015 make sure you report at least one PQRS measures group on one claim for at least one patient in 2013
  • Report successfully for the entire year starting in 2014 in order to avoid future PQRS penalties
  • Report successfully by 2013 or 2015, depending on the size of your group,  to avoid both the PQRS penalty and the additional 1 percent VBPM adjustment

In 2015, the VBPM will be implemented for group practices with 100 or more physicians. By Jan. 1, 2017, all practices will be phased in, regardless of the number of physicians.

CMS has released a new PQRS interactive timeline that will help providers identify key program dates for PQRS between 2014 and 2016.

Last Updated: 2/20/2014

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