PQRS Intro


NOTE: Trish Merchant, our SOS Business Development Manager, stepped up to my request for guest bloggers. Hope you find her information useful.


Recently, we’ve had a few customer support calls asking about PQRS. I thought it would be a good subject to share on the SOS blog.

PQRS or Physician Quality Reporting System is a voluntary reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality measures for services in the covered Physician Fee Schedule (PFS) by eligible professionals. While the program is considered voluntary, starting in 2015, eligible professionals who do not satisfactorily submit data on quality measures will see a payment adjustment in their Medicare claims.

According to the CMS website, the PQRS program provides an incentive payment to practices with eligible professionals who provide and report on certain services. Eligible professionals are identified on the claim by their NPI or Tax ID number. SOS customer organizations with eligible professionals can choose to report data via their Medicare Part B claims. Other ways to report include using a registry; reporting directly to CMS via qualified EHR system; or using a qualified PQR data submission vendor.

Participating in this program where eligible professionals satisfactorily submit quality measures data, via one of the above mentioned reporting vehicles, will qualify a provider to earn a PQR incentive payment. The percentage of the payment is based on Medicare Part B Physician Fee Schedule and is an estimate of allowed charges for a covered professional service that was rendered during the same reporting period. Percentages and documents for this incentive vary from year to year so it is important to verify the correct documents are reviewed.

To learn more about this program and how to get started, please visit the CMS website. For questions on how to set up SOS Office Manager for these services, SOS customers with current support agreements can contact the SOS Support Desk.


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