PV-PQRS Deadline Approaching

Physicians must act now to avoid a 1.5% penalty adjustment to their Medicare fee schedule amount in 2015 and a 2% penalty adjustment in 2016.  October 15, 2013 is the last day to register to participate in PV-PQRS, the Physician Value-Physician Quality Reporting System, previously referred to as PQRS.  In 2013 and 2014, eligible professionals (EPs) and group practices that satisfy PV-PQRS reporting requirements are eligible to earn an incentive payment of 0.5 % of total allowed charges.

EPs can choose to report PV-PQRS data via claims submission, registry-based reporting, or electronic health record (EHR) data submission.  The group practice reporting option (GPRO) varies based on the number of EPs in the group.  A practice with 2 to 24 EPs can report via the registry method and a group of 25 or more EPs can report via a web interface.   An EP or GPRO can “self-nominate” or elect to report PV-PQRS by registering with the Centers for Medicare and Medicaid Services (CMS) online portal.  Registration is available at through October 15.

Another option exists for EPs and GPROs that choose to forgo the incentive payment but want to avoid the penalty.  The administrative claims option is a new reporting mechanism to avoid the 2015 PV-PQRS payment adjustment.    Under this option, the Centers for Medicare and Medicaid (CMS) will analyze claims data to determine which measures were satisfactorily reported for the 2013 program year.  

Registration in the portal also allows physician groups of 100 or more EPs to elect the quality-tiering approach to calculate the value-based payment modifier (VM) for calendar year 2015.  By selecting either to submit PV-PQRS data or choosing the administrative option, these large groups can avoid a 1% penalty in 2015 and 2016.  In this program, large physician groups are either rewarded or penalized based on the measured quality of care and the associated cost of care.  For example, high quality performance associated with lower costs may qualify for a 2% increase, while low quality performance associated with higher costs may impose a 1% penalty. Note that the VM program only applies to physician groups of 100 or more EPs.

For more information on PV-PQRS reporting and the Value-Based Payment Modifier, refer to the CMS website.


Nancy Clark is a Manager in the Health Care Services Group. Her expertise focuses on coding and documentation audits, which includes chart review and report compilation.

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