An Overview of the Physician Quality Reporting System (PQRS)

PQRS is a quality reporting program that, prior to 2015, had been using incentive payments to encourage eligible professionals to report on specific quality for services covered by the Physician Fee Schedule (PFS) provided to Medicare Part B Fee-for-Service (FFS) beneficiaries to both 1) ensure that patients receive the proper care at the proper time and 2) quantify how often they, as providers, meet a particular quality metric. With a feedback report provided by CMS, EPs may compare their performance with their peers.

Starting in 2015, PQRS will apply downward payment adjustments, or penalties, to EPs who do not satisfactorily report data on quality measures for covered professional services or satisfactorily participate in a qualified clinical data registry (QCDR).

In the 2015 final rule, CMS establishes requirements primarily related to the 2017 PQRS payment adjustment. For 2015, 20 new individual measures and 2 measures groups have been added to fill existing measure gaps. In addition, 50 measures have been removed from reporting for the PQRS. The PQRS individual measure set now totals 255 measures. In general, EPs need only report 9 measures covering 3 National Quality Strategy (NQS) domains.

How to Get Started: To use PQRS, a provider should do the following:

  1. Determine if you are eligible.
  2. Identify which reporting method best fits your practice.
  3. Based on the reporting method chosen, the next step is to determine which measure reporting option works best for your practice. For example, you can report individual measures or measures groups. There are specific criteria for each reporting option.
  4. Review information regarding the PQRS Payment Adjustment to determine whether you meet the requirements for avoiding a payment adjustment.

For more information, visit:

Who is an "Eligible Professional?”

  • Medicare physicians include: MD, DO, DPM, DDS, OD, and DC.
  • Medicare practitioners include: Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, Clinical Social Worker, Clinical Psychologist, Registered Dietician, Nutrition Professionals, and Audiologists.
  • As of 2014, physicians or practitioners who practice in critical access hospitals (rural or certified as a necessary provider in urban areas) are eligible to participate in PQRS via a registry or EHR, but not claims-based reporting.
  • For more information about the definition of Eligible Professionals, please visit:

Are you an Individual or Group?

Reporting is linked to an individual's tax identification number (TIN); if a provider practices or submits claims under more than one TIN, he or she should be sure to participate in PQRS through each TIN.

Group Practices are defined as a single TIN that consists of 2 or more eligible professionals. The group must meet reporting requirements across all providers within that group, and all members of the group will meet the PQRS requirements, regardless of whether all members participated in the collection of all measures or not.

The International Spine Intervention Society provides this information for educational purposes only and always recommends that providers consult the CMS Web site for additional information. It is each provider's responsibility to know and to understand the requirements and consequences of each reporting program in which he or she participates.

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