The PQRS or the Physician Quality Reporting System started out in 2007 as simplistic, incentive-based reporting program for eligible healthcare providers service organizations with the primary objective of reporting high-quality data to the Centers for Medicare and Medicaid Services or CMS through the use of Medicare claims forms.
In line with this, transitioning from using fee-for-service payment methods to more value-based payment methods, the Healthcare revenue cycle management will implement the said changes necessary in the system in the upcoming years.
The Physician Quality Reporting System will start instigating a negative payment adjustment to EP or eligible professional who fails to report high-quality data and information for their covered services from the onset of the implemented program in year 2015.
Eligible professionals or EPs who fail to report high-quality data and information from their all their covered services made in 2013 are now obliged to receive a 1.5 percent reduction in physicians’ payments in the year 2015, but as the year 2016 arrives, the total physicians’ payment reduction rate from eligible professionals or EPs’ covered services’ will increase to be 2 percentage.
Medicare providers have defined the list of eligible professionals or EPs that are subject to report the Physician Quality Reporting System quality measures.
These eligible professionals include:
- Doctors of medicine
- Doctors of osteopathy
- Doctors of podiatric medicine
- Doctors of optometry
- Doctors of oral surgery
- Doctors of dental medicine
- Doctors of chiropractic
Eligible Practitioners have also been included in the list of those that are subject to report the Physician Quality Reporting System quality measures.
These eligible practitioners include:
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
- Certified registered nurse anaesthetists
- Anaesthesiology assistants
- Certified nurse midwives
- Clinical social workers
- Clinical psychologists
- Registered dieticians
- Nutrition professionals
In addition to eligible professionals and practitioners, therapists have also been included in the list of those that are subject to report the Physician Quality Reporting System quality measures.
These eligible therapists include:
- Physical therapists
- Occupational therapists
- Qualified speech-language therapists
Healthcare providers that report to the Physician Quality Reporting System must provide on information on at least nine measures found in three National Quality Strategy Domains.
A physician is also entitled to report on “cross-cutting” measure, a non-specialty measure and one of the nine required measures, if he or she sees at least one Medicare patient through face-to-face encounters.
In retrospect, the primary goal of the CMS or Centers for Medicare and Medicaid Services through the PQRS or Physician Quality Reporting System is to ensure high-quality service to healthcare providers and payers and further streamline its practices.