Critical for 2013: Participation in Medicare quality reporting program

To avoid payment penalties in 2015, practitioners who are Medicare providers must participate in Medicare’s Physician Quality Reporting System during 2013

By Government Relations staff

Nov. 29, 2012—Here’s one more reminder from the APA Practice Organization for practitioners who are Medicare providers: If you don’t yet participate in Medicare’s Physician Quality Reporting System (PQRS), you must begin doing so in 2013 or you will face payment penalties starting in 2015. 

Since 2007, Medicare has offered incentives in the form of bonus payments to eligible professionals, including psychologists, who report data on designated outpatient service measures. As a result of the Patient Protection and Affordable Care Act of 2010, the program must switch from awarding bonuses for satisfactory participation to imposing penalties for the failure to successfully report on PQRS measures.

In 2013 and 2014, psychologists who successfully participate in PQRS will earn an additional 0.5 percent payment on all of their Medicare charges. Beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will no longer provide bonuses but instead will impose penalties on those who do not successfully report PQRS measures. The payment penalties will be 1.5 percent in 2015 and 2 percent in 2016.

Current nonparticipants may wonder why they need to get involved in 2013 when penalties do not apply until 2015. As a bonus program, Medicare’s payments have been retroactive. Eligible professionals submitted their Medicare claims and were paid for their services with the PQRS bonus payments distributed months later.

But now that PQRS will become a penalty-based program, Medicare must operate prospectively in order have the time needed to analyze reporting data before applying any payment adjustments. The 1.5 percent penalty adjustments for 2015 will be based on 2013 reporting data, while the 2 percent penalty for 2016 will be based on 2014 reporting data. Penalties will apply to all Medicare charges by a provider.

To help eligible professionals avoid payment penalties, CMS has taken steps to facilitate reporting for those Medicare providers who are new to PQRS. Psychologists participating in PQRS for the first time will only need to report one service measure for at least one applicable patient in 2013 in order to avoid penalties in 2015.

Those providers who already participate in PQRS are required as usual to report on 50 percent of applicable Medicare cases in 2013.

Most psychologists must prepare to get involved. According to Medicare, only 3 percent of psychologists who are Medicare providers already participate in PQRS.

The APA Practice Organization will provide further details about reporting measures for 2013 and additional guidance about PQRS participation in the next issue of this e-newsletter and in the 2013 winter issue of Good Practice magazine. Meanwhile, please visit the Quality Improvement Programs page at our Practice Central website for more information.