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Medicare Quality Reporting Programs: What eligible professionals need to know for 2016

There is still one more performance year to go under the current Medicare quality reporting programs— the Physician Quality Reporting System (PQRS) and the Medicare Electronic Health Record Incentive Program (meaningful use). The 2016 reporting year, which affects the 2018 payment year, will be the last reporting year before these programs sunset on December 31, 2018.

To assist physicians, the California Medical Association (CMA) has prepared this tip sheet, which includes a summary of each program, critical deadlines ahead for this final year and helpful links to checklists that help practices successfully report.

Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) is a Centers for Medicare and Medicaid (CMS) quality improvement program that uses a combination of incentive payments and penalties to promote reporting of quality data. The program provides an incentive payment to eligible professionals (EPs) who satisfactorily report data on quality measures for covered physician services furnished to Medicare Part B fee-for-service beneficiaries. 

EPs who do not satisfactorily report quality measure data to meet PQRS requirements for the 2016 reporting year will be subject to a negative PQRS payment adjustment on all Medicare Part B Physician Fee Schedule services rendered in 2018, referred to as the payment adjustment year. 

View the 2015-2017 PQRS timeline to keep track of PQRS-related milestone dates and corresponding resources. 

  • For step-by step instructions on how to implement PQRS, view the How to Get Started page. In addition, learn more about PQRS and how to participate.
  • For information on quality measures including specification and selection, visit the Measures Codes page.
  • For information on payments, visit the Analysis and Payment page. Note that incentive payments were only authorized through 2014 program year reporting.
  • For information on negative payment adjustments, review the Payment Adjustment Information page.

If you have questions or need assistance with PQRS reporting, contact the QualityNet Help Desk. The Help Desk is available Monday – Friday; 7:00 a.m. – 7:00 p.m. Central Time (CT): 

Electronic Health Record Incentive Programs (Meaningful Use) 

Beginning in 2011, the Medicare Electronic Health Record (EHR) Incentive Program was established to encourage physicians and hospitals to adopt, implement, upgrade and demonstrate “meaningful use” of certified EHR technology.

  • EHR/Meaningful Use Objectives and Measures
  1. EPs are required to attest to a single set of objectives and measures. This replaces the core and menu structure of previous stages.
  2. For EPs, there are 10 objectives. Click here to view the 2016 measure specification sheets.
  3. In the 2016 reporting year, EPs must attest to objectives and measures using EHR technology certified to at least the 2014 Edition or the 2015 Edition or a combination of the two. 
  • EHR/Meaningful Use Reporting Period and Payment Adjustments
  1. For all returning participants, the EHR reporting period is a full calendar year, from January 1, 2016, through December 31, 2016. Returning participants who successfully demonstrate meaningful use for this period and satisfy all program requirements will avoid the payment adjustment in 2018.
  2. For participants that have not successfully demonstrated meaningful use in a prior year, the reporting period will be any continuous 90-day period during the 2016 calendar year. New participants who successfully demonstrate meaningful use for this period and satisfy all program requirements will avoid the payment adjustment in CY 2018.
  3. The 2016 attestation deadline is February 28, 2017. 
  4. For additional information click here.

The EHR Information Center is available to assist with registration and attestation system inquiries. Hours of operation are 7:30 a.m. – 6:30 p.m. (Central) Monday through Friday, except federal holidays:

  • Phone: (888) 734-6433 (press option 1)
  • TTY: (888)734-6563 

Click here to view the full Medicare Quality Reporting Programs Overview

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