PQRS Medicare EHR Incentive Pilot

Overview

Eligible Professionals (EPs) now have the option to satisfy the Meaningful Use objective to report clinical quality measures (CQMs) to CMS through a voluntary Physician Quality Reporting System (PQRS)-Medicare EHR Incentive Pilot program. In so doing, providers will position themselves for dual-incentive payments under both the Medicare EHR Incentive Program (Meaningful Use) and PQRS. EPs who wish to participate in the electronic reporting pilot must submit 12 months of CQM data between January 1, 2014, and February 28, 2014.

Through this pilot program, EPs may report CQMs to CMS through one of two electronic submission methods:

1) EHR Data Submission Vendor-Based Reporting Option:

EPs can choose to use a PQRS "Qualified" EHR Data Submission Vendor to:

• Submit aggregate CQM results from the EP's ONC-certified EHR to CMS in an XML file on the EP's behalf and

• Submit PQRS data at an individual patient level using data from the EP's EHR system. This patient-level data must be submitted in the Quality Reporting Data Architecture (QRDA) Category 1 format

2) Direct EHR-Based Reporting Option:

With this reporting method, EPs submit CQM data at an individual patient level directly from the EHR system. This data must be submitted in the QRDA Category 1 format. CMS will then calculate CQM results using a uniform calculation process. In order to submit PQRS measures via EHR Direct, EPs must have an EHR that is capable of submitting EHR-derived data direct to CMS. A challenge for many practices, there were only 24 EHR vendors that successfully tested for EHR Direct with CMS for 2013 PQRS EHR Direct reporting.

CMS has posted a detailed decision tree to help interested EPs select the appropriate reporting method. The 2013 Physician Quality Reporting System Decision Tree includes more detailed information on reporting options for both PQRS and the PQRS-Medicare EHR Incentive Pilot, and can be found at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013_PQRS_DecisionTree_01292013.pdf