PQRS reporting required in 2013 to avoid 2015 payment cuts

January 8, 2013

Physicians, including optometrists, who do not report Medicare Physician Quality Reporting System (PQRS) quality measures during 2013 will see their Medicare reimbursements reduced 1.5 percent in 2015, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

When Congress extended PQRS bonuses through 2014, lawmakers also enacted provisions for penalties to begin in 2015.

The CMS, as it has done with other penalty provisions, will determine which practitioners to penalize based on performance two years in advance of the 2015 penalty.

Beginning that year, all Medicare practitioners not participating in PQRS will be subject to a penalty.

Payment adjustments will begin in 2015 with a 1.5 percent reduction in payments and increase to 2 percent in 2016 and beyond.

Medicare is transforming its voluntary Physician Quality Reporting System from rewarding doctors who participate to punishing doctors who do not, including penalties in 2015 for doctors who do not attempt to report measures for PQRS in 2013, noted Rebecca Wartman, O.D., who tracks the PQRS program for the AOA Advocacy Group.

The AOA Advocacy Group is concerned that many practitioners may not yet be aware of the planned 2015 Medicare PQRS payment penalties, and, moreover, may not be aware those penalties will be based on quality measure reporting performance in 2013.

Health care practitioners can continue to earn bonuses through the PQRS this year and next, with incentive payments set at 0.5 percent in both 2013 and 2014.

However, practitioners need not qualify for PQRS bonuses in order to avoid penalties under the new mandatory reporting program, the AOA Advocacy Group emphasized.

To secure exemption from the 2015 payment penalty, practitioners must report at least one PQRS quality measure on a Medicare claim during 2013.

“Avoiding the penalty is simple,” Dr. Wartman said. “Practitioners must simply report at least one PQRS measure, one time, on one claim to demonstrate an attempt to participate in the quality reporting program. However, it would be far better to fully participate in PQRS and receive the extra 0.5 percent payment for 2013 and 2014.”

“At this point, the CMS is simply trying to introduce as many practitioners as possible to quality reporting and get them acculturated to the process,” Dr. Wartman said.

In future years, the CMS will almost certainly increase the quality reporting levels required to avoid payment penalties.

The AOA will be introducing new webinars and education materials on PQRS in the near future.

For additional information, see the AOA website PQRS page (www.aoa.org/ PQRS).


  1. to avoid the penalty in 2015, how do i report a PQRS measure in a claim in 2013? i do enter a diagnosis, like macular degeneration, in the claim. does it count as a PQRS measure? how do i do differently than what i have been doing in filling out a claim?

  2. I would suggest visiting the AOA website that has tons of information on this. https://www.excelod.com/pqrs/ You can also go to the categories on the right side of this page to get the links or ask the codeheads.

  3. thanks for your help. i appreciate it.

  4. Hey John,

    Also remember that reporting via a registry is always an option. Registry reporting has a history of being more accurate, as well as making avoiding the penalty a pain-free process. I’d suggest checking out http://www.pqrspro.com.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: