Did you successfully report at least one quality measure for the Physician Quality Reporting System (PQRS) in 2013? If not, you saw a 1.5 percent penalty in your 2015 Medicare Part B reimbursements.

The penalties will continue beyond this year and not just for the PQRS program. The Centers for Medicare and Medicaid Services (CMS) Value-Based Payment Modifier (VBPM) program also uses PQRS data to determine a practice’s performance evaluating “quality vs. cost.”

By the Numbers…PQRS and VBPM Penalty Percentages by Year for Non-PQRS Reporters
There are consequences associated with the decision not to report for PQRS. You could see separate penalties for both PQRS and the VBPM program.

2015—Penalties Assessed for 2013

  • PQRS: 1.5 percent for all providers who did not report at least one quality measure
  • VBPM: 2 percent for groups of groups of > 100 providers under the same taxpayer identification number (TIN) that did not report PQRS data

2016—Penalties Assessed for 2014

  • PQRS: 2 percent for all providers who did not successfully report PQRS data
  • VBPM: 2 percent for groups of > 10 providers under the same TIN

2017—Penalties Assessed for 2015

  • PQRS: 2 percent for all providers who did not successfully report PQRS data
  • VBPM: 2 percent for groups of < 10; 4 percent for groups of > 10

Stay Ahead of the Curve When it Comes to PQRS and VBPM
Reporting PQRS has become a vital part of maintaining a healthy Medicare reimbursement.
The good news is that you still have control over whether you see reductions in your Medicare reimbursement for the 2017 calendar year and beyond. What you do now will determine your reimbursement in the near future.

Here are two ways you can feel more confident about decisions you make regarding quality reporting:

  1. Access the latest PQRS education and resources available to you, including the Pennsylvania Medical Society’s (PAMED’s) updates in the Daily Dose and on its website at www.pamedsoc.org/incentivesandpenalties.
  2. Make sure you have the right technology in place.

Additional resources from PAMED:

  • Chart that outlines the 2015 requirements
  • PQRS quality reporting video
  • Members who have questions can contact our experts at (717) DOC-HELP, that’s (717) 362-4357.
  • Updates and insights at live regional practice manager meetings that are free to members—Register now for spring meetings

If you’re struggling to understand what technology is right for you, PAMED’s subsidiary organization PMSCO Healthcare Consulting can provide expert advice on health care technology and EHRs.

Those looking for an overview of 2015 PQRS and VBPM requirements can also register for a free CMS call on April 7.