Medicare's Physician Quality Reporting System (PQRS)
Continues for 2011
In 2011, Medicare's Physician Quality Reporting Initiative (PQRI) has been renamed the Physician Quality Reporting System (PQRS). Medicare providers who participate in the PQRS in 2011 will be eligible for incentive payments of up to 1 percent of their Medicare physician fee schedule allowable charges. The incentive payment is calculated based on a physician's estimated total Medicare Part B payments for claims submitted within two months of the end of the reporting period.
For claims- and registry-based reporting in 2011, there are two reporting periods:
- January 1 to December 31, 2011; and
- July 1 to December 31, 20111
For 2011, there are 1942 individual measures and 14 measures groups on which to report.
For more information on PQRS, including detailed guidance on methods and metrics for successful participation, please visit www.cms.gov/pqri/. You may also contact your regional or national professional society for additional information on PQRS-related information specific to your specialty.
1 Federal Register Vol. 75, No. 228. Nov. 29, 2010. Rules and Regulations.
2 Final rule does not state a total number of measures. This figure was taken from a CMS presentation, available at
www.cms.gov/PQRI/Downloads/November10NationalProviderCallpresentations.
Coverage policies may vary by insurer or even between plans offered by the same insurer. This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current, the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions.