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PQRS: Last Day for Claims-Based Reporting
The Physician Quality Reporting System (PQRS) is a quality reporting program by the Centers for Medicare & Medicaid Services (CMS) that uses negative payment adjustments to promote reporting of data on quality measures. The Value-Based Payment Modifier (VBM) program is a separate CMS program that assesses quality and cost performance. The VBM is based partially on participation in PQRS. Under the VBM program, physicians are subject to upward, neutral, or downward payment adjustments based on quality of care furnished compared with the cost of care during a performance period. To fulfill the quality reporting requirement for both programs, you simply report data on quality measures to PQRS.
CMS
02/24/2017
All solo physicians and group practices who get paid under or based on the Medicare Physician Fee Schedule must comply with quality reporting requirements on an annual basis. Failure to report data on quality measures to Medicare for the 2016 PQRS program year will result in an automatic 2-percent pay cut under PQRS, plus another automatic 2-percent to 4-percent pay cut under the VBM program, all in 2018. To avoid the automatic penalty under each program, or “negative payment adjustment,” choose a reporting mechanism that best fits your practice, and submit your 2016 data by the deadline.
Report your 2016 data on quality measures to CMS. Claims processed through Novitas Solutions, the Medicare administrative contractor (including claims adjustments, reopenings, or appeals), must reach the national Medicare claims system data warehouse (National Claims History file) by Feb. 24, 2017, to be included in the 2016 PQRS and VBM analysis.
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