In an effort to help you better understand the Physician Quality Reporting System (PQRS), the AOA has put together the following questions and answers:
What is the Physician Quality Reporting System?
On Dec. 20, 2006, President Bush signed into law the Tax Relief and Health Care Act of 2006. Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI). As of 2011, the program is now titled Physician Quality Reporting System (PQRS).
Is PQRS voluntary?
Yes. While CMS is required by law to establish the program, physicians are not required to participate in the program. However, physicians who do participate are eligible for a bonus payment, subject to a cap, of 1.0% of total allowed charges for covered Medicare physician fee schedule services
When does the program begin? End?
PQRS has entered its fifth year. The reporting period for 2011 is Jan. 1- Dec. 31, 2011. Eligible professionals report on a designated set of quality measures for services provided between these dates
What measure groups will be used for PQRS?
If you are participating in the AOA CAP for PQRS via HealthFusion you are able to choose from two measure groups:
Is there a fee to participate in the CAP PQRS?
Yes. There is a $199 fee for AOA members and a $299 fee for non-members.
Will I be audited?
CMS requires that each registry perform a validation of the data submitted. You may be selected to submit a few of your charts for a reabstraction. Make sure to keep track of the thirty charts you select for submission and track them with their Patient Identifier.
Can a bonus payment be denied?
Yes. While the physician determines which measures to use, CMS will validate (i.e., through sampling) whether the applicable measures have been reported. The agency's determinations are excluded from formal administrative or judicial review. The agency will establish an informal inquiry process.
If I have questions about CAP PQRS, whom should I contact?
If you have questions, you should contact Angi Beranek, MPA, Manager, Division of Clinical Quality. Phone: (800) 621-1773, ext. 8198, email: aberanek@osteopathic.org.