Analysis and Payment

Each year, the Physician Quality Reporting System (PQRS) incentive payment and the PQRS feedback report are issued through separate processes. PQRS feedback report availability is not based on whether or not an incentive payment was earned. Feedback reports will be available for every Taxpayer Identification Number (TIN) under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported at least one valid PQRS measure a minimum of once during the reporting period. PQRS participants will not receive claim-level details in the feedback reports.

Incentive Payments

Eligible professionals who satisfactorily report quality-measures data for services furnished during a PQRS reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period.

Below are the authorized incentive payment amounts for each program year:

• 2010 PQRS – 2.0%
• 2009 PQRS – 2.0%
• 2008 PQRS – 1.5%
• 2007 PQRS – 1.5% subject to a cap

The Affordable Care Act authorized incentive payment through 2014;

• 2011 PQRS – 1.0%
• 2012 PQRS – 0.5%
• 2013 PQRS – 0.5%
• 2014 PQRS – 0.5%

Incentive payments for each program year are issued separately as a single consolidated incentive payment in the following year. Incentive payments are issued to the first valid group location listed under the TIN; or, for solo practitioners, to the first valid practice location listed under the TIN. The Medicare claims-processing contractors (Carrier or A/B MAC) will make the payment electronically or via check, based on how the TIN normally receives payment for Medicare Part B PFS covered professional services furnished to Medicare beneficiaries. If a TIN submits claims to multiple Carriers or A/B MACs, each contractor may be responsible for a proportion of the TIN incentive payment equivalent to the proportion of Medicare Part B PFS claims the contractor processed during the applicable reporting period. Note: If splitting an incentive across contractors would result in any contractor issuing a PQRS incentive payment less than $20 to the TIN, the incentive will be issued by fewer contractors than may have processed PFS from the TIN for the reporting period. The PQRS incentive payment can be offset by an outstanding debt for the TIN.

The incentive payment, with the remittance advice, will be issued by Carrier/MAC and identified as a separate payment under the PQRS. Medicare contractors will use the indicator of LE ("Levy") to indicate federally mandated payments. LE will appear in the PLB-03-1 segment of the 835. In an effort to further clarify the type of incentive payment issued LE will appear on the remit, along with a 4-digit code to indicate the type of incentive and reporting year.

For example, eligible professionals will see the LE to indicate an incentive payment, along with PQ10 to identify that payment as the 2010 PQRS incentive payment. Additionally, the paper remittance advice will read, "This is a PQRS incentive payment." The year will not be included in the paper remittance.

Once we begin distributing incentive payments for a particular program year and if your incentive does not arrive or the incentive payment amount does not match what is reflected in your PQRS feedback report, contact your Carrier or A/B MAC (click on the "Help Desk Support" link at left for contact information). Note: The incentive amount may differ by a penny or two from what is reflected in your feedback report due to rounding.

2012 PQRS

2012 Interim Feedback Dashboard User Guide

The Interim Feedback Dashboard User Guide is designed to assist eligible professionals and their authorized users with accessing and interpreting the claims-based 2012 interim PQRS Dashboard data. The 2012 Interim Feedback Dashboard User Guide is designed to assist eligible professionals, and their authorized users, with accessing and interpreting the 2012 interim Dashboard data. The Dashboard allows organizations and eligible professionals to log-in to a web-based tool and access interim PQRS data on a quarterly basis in order to monitor the status of claims-based individual measures and measures group reporting.  This document is available in the "Downloads" section below.

Note: The Dashboard does not provide the final data analysis for full-year reporting, or indicate 2012 PQRS incentive eligibility. The Dashboard will only provide claims-based data for 2012 interim feedback. Data submitted via registry reporting, CMS-selected Group Practice Reporting Option (GPRO), Center for Medicare and Medicaid Innovation (CMMI, includes Physician Group Practice [PGP] and Accountable Care Organizations [ACO] participants), or qualified Electronic Health Records (EHR) systems will not be included for purposes of the 2012 Dashboard data feedback. Data submitted for 2012 PQRS reporting via methods other than claims will be available for review in the fall of 2013 through the final PQRS feedback report.

2012 PQRS Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures

The following documents pertaining to the 2012 Physician Quality Reporting System Measure- Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures are available in the zip file titled "2012 Physician Quality Reporting System Measure Applicability Validation Documents" in the "Downloads" section below:

• 2012 Physician Quality Reporting System Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures - provides guidance for those eligible professionals who satisfactorily submit quality data codes for fewer than three PQRS measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures

• 2012 Physician Quality Reporting Measure-Applicability Validation Process Release Notes - the release notes for the changes occurring for the 2012 PQRS Measure- Applicability Validation (MAV) Process

• 2012 Physician Quality Reporting System Measure-Applicability Validation Process Flow - a chart that depicts the Measure Applicability Validation (MAV) Process

2012 Quality Data Code (QDC) Error Reports

1st Quarter 2012 PQRS QDC Error Report by Provider Specialty.  This report, which is available in the "Downloads" section below includes claims data for services provided from January 1, 2012 through March 30, 2012 and processed by March 30, 2012.

1st Quarter 2012 PQRS QDC Error Report by Measure.  This report, which is available in the "Downloads" section below includes claims data for services provided from January 1, 2012 through March 30, 2012 and processed by March 30, 2012.

2011 PQRS

Guide for Understanding 2011 PQRS Incentive Payment

This document describes how the 2011 PQRS incentive payment was calculated for 1) individual Eligible  professionals, and 2) self-nominated and CMS-selected Group Practice Reporting Option (GPRO)
participants. To review this user guide view the "Downloads" section below.  

2011 PQRS Feedback Report User Guide

The PQRS Feedback Report User Guide is designed to assist eligible professionals and their authorized users with accessing and interpreting the 2011 PQRS feedback reports. The 2011 PQRS incentive payments are scheduled to be made in the fall of 2012. Feedback reports reflect data from the Medicare Part B Physician Fee Schedule claims received with dates of service between January 1, 2011 – December 31, 2011 that were processed into the National Claims History by February 24, 2012.  To review this user guide view the "Downloads" section below. 

2011 Quality Data Code (QDC) Error Reports

1st Quarter 2011 PQRS QDC Error Report by Provider Specialty.  This report, which is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through March 25, 2011 and processed by March 25, 2011.

1st Quarter 2011 PQRS QDC Error Report by Measure.  This report, which is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through March 25, 2011 and processed by March 25, 2011.

2nd Quarter 2011 PQRS QDC Error Report by Provider Specialty.  This Report is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through June 30, 2011 and processed by June 24, 2011.

2nd Quarter 2011 PQRS QDC Error Report by Measure.  This Report is available in the "Downloads" section below includes claims data for services provided from January 1, 2011 through June 30, 2011 and processed by June 24, 2011.

3rd Quarter 2011 PQRS QDC Error Report by Provider Specialty.  This Report is available in the "Downloads" section below. This report includes claims data for Services provided from January 1, 2011 through September 30, 2011 and Processed by September 30, 2011.

3rd Quarter 2011 PQRS QDC Error Report by Measure.  This Report is available in the "Downloads" section below. This report includes claims data for services provided from January 1, 2011 through September 30, 2011 and Processed by September 30, 2011.

4th Quarter 2011 PQRS QDC Error Report by Provider Specialty.  This Report is available in the "Downloads" section below. This report includes claims data for Services provided from January 1, 2011 through December 30, 2011 and Processed by December 30, 2011.

4th Quarter 2011 PQRS QDC Error Report by Measure.  This Report is available in the "Downloads" section below. This report includes claims data for services provided from January 1, 2011 through December 30, 2011 and Processed by December 30, 2011.

Location of Previous Program Year Documents

All previous program year documents will be moved from this page to their appropriate program year section page.