Winning the Medicare Quality Bonus

Want to earn a bonus and avoid paying a penalty in 2015 under the Physician Quality Reporting System (PQRS)? Then follow these simple government instructions.

If you are paid under the Medicare Physician Fee Schedule (PFS), you will be subject to payment penalties beginning in 2015. The providers and group practices that do not satisfactorily report data on quality measures during the 2013 program year will be subject to a 1.5% payment reduction in their PFS charges.

Individual and Group Practices

Individuals and group practices participating in the PQRS must meet one of the following criteria to avoid getting nicked in 2015.

For individuals who want to earn a 0.5% bonus, you must meet one of the following criteria during the 2013 PQRS program year.

• Meet the requirements outlined in the 2013 PQRS measure specifications found here.
• To get the bonus, you must report at least:
  • One valid measure via claims, participating registry, or through a qualified Electronic Health Record (EHR) or
  • One valid measures group via claims or participating registry.
• Elected to participate in the administrative claims-based reporting mechanism October 18, 2013.

Groups in ACOs

Groups in Accountable Care Organizations (ACOs) participating in the Group Practice Reporting Option (GPRO) can avoid the penalty if one of the following criteria is met during the same 2013 PQRS program year:

• Meet the requirements outlined in the 2013 PQRS GPRO Fact Sheet
  • Report specific ACO/GPRO measure through the Web Interface or
  • Report at least 3 registry measures (for 80% of the group’s eligible patients for each measure) for the GPRO outlined in the 2013 PQRS Measure Specification for Claims/Registry Reporting of Individual Measures.
• Report at least one valid measure through the Web Interface or participating registry
• Elected to participate as a GPRO in the administrative claims-based reporting mechanism by October 18, 2013

Here’s where you can view the PQRS Payment Adjustments Tip Sheet.

Good Luck!