PQRS and VBM

There are various Quality Reporting Programs available to eligible providers by CMS. Please see below for more information on each program.

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Value-Based Modifier Payment Modifier

The Value Modifier provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period. In the future, the Value Modifier will be used to adjust Medicare PFS payments to non-physician eligible professionals (EPs), in addition to physicians. The Value Modifier is an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS. It is applied at the Taxpayer Identification Number (TIN) level to physicians (and beginning in 2018, to non-physician EPs) billing under the TIN.

Value Modifier Timeline

How to obtain a QRUR

Value-Based Payment Modifier Program Website

PQRS: Getting Started

The Physician Quality Reporting System (PQRS) is a quality PQRSiconreporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time.

By reporting on PQRS quality measures, individual EPs and group practices can also quantify how often they are meeting a particular quality metric. Beginning in 2015, the program will apply a negative payment adjustment to individual EPs and PQRS group practices who did not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule (MPFS) covered professional services in 2013. Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment.

Note: PQRS was formerly known as the Physician Quality Reporting Initiative (PQRI).

Getting Started

Physician Quality Reporting System (PQRS) Website
PQRS Overview Fact Sheet
2015 PQRS Payment Adjustment Feedback Report User Guide

See what PQRS data your provider has successfully submitted by visiting: https://qnpapp.qualitynet.org/pqrs/home.html

2016 PQRS Guide
PQRS Cross-Cutting Measures
2016 PQRS Qualified Registries
Guide for Obtaining a New EIDM Account

Training Documents

PQRS Reporting for 2015

Recorded Webinars

PQRS: Reporting for 2015 and Beyond

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