PQRS 2013: Procrastinators Rejoice! It STILL Is Not Too Late!

Any provider who has continued to procrastinate with regards to the PQRS program still has an opportunity to avoid the upcoming payment penalties and possibly even receive an incentive payment for 2013.  Any provider who successfully participates in PQRS in 2013 can receive an incentive payment of 0.5% for all of their Medicare payments; any provider who fails to report on PQRS in 2013 will be subject to a 1.5% payment penalty on all Medicare payments in 2015.

In order to receive an incentive payment for participation in 2013, eligible providers must report PQRS codes on at least 50% of all applicable studies if using claims-based reporting and 80% of applicable studies if using registry or EHR reporting.  Since we have now passed the halfway point in 2013, claims-based reporting is not an option.  However, eligible professionals can report PQRS codes via the registry until March 31, 2014.  A list of certified PQRS registries was made available on the CMS website in May 2013.  If a provider still wishes to earn an incentive payment for 2013, providers are encouraged to contact a certified registry to begin the reporting process.  It is also worth noting that all current radiology measures are able to be reported through registry reporting.  For a list of PQRS radiology measures, descriptions and documentation requirements, please click here.

Break Away from the Static

If a provider does not ‘successfully participate’ in PQRS in 2013, eligible providers have the following two additional options to avoid penalties:

  1. Report one valid measure or measures group:  CMS further clarifies this as “one instance of a measure or measures group can be submitted according to the requirements set forth in the 2013 PQRS measure specifications”
  1. Participate in the CMS calculated administrative claims-based reporting mechanism:  Eligible providers can enroll in this option and elect to have CMS review their claims to determine if the PQRS documentation was sufficient in order to avoid the 2015 PQRS penalty of 1.5%.  If this option is chosen, the provider must enroll with CMS no later than October 15, 2013.

In order to enroll in the administrative claims option, the eligible provider must first register for an Individuals Authorized Access to the CMS Computer Services (IACS) account.  Providers can register for an IACS account through the following website: https://applications.cms.hhs.gov/

After setting up the IACS account, providers can register for the administrative claims option beginning on July 15th through the following website: https://portal.cms.gov/

While eligible providers still have viable options for 2013 incentive payments and avoiding the 2015 payment penalty, the outlook for 2014 is not quite so rosy.  Medicare’s proposals for 2014 include the following:

  • Increasing the number of measures required for satisfactory reporting from three to nine
  • One new radiology measure for measuring lower back pain
  • Five (yes FIVE) new radiology measures related to radiation exposure for CT studies
  • Additional requirements/penalties for Value Based Modifiers based on PQRS participation.

As additional information regarding the 2014 PQRS program is finalized, updates will be provided.  For additional information on the PQRS program, please feel free to contact me at wendy.driscoll@radadvocate.com.

Best regards,

Wendy Driscoll, MBA
Senior Client Manager