Physician Quality Reporting Initiative

The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries.

To participate in the 2011 Physician Quality Reporting, individual eligible professionals may choose to report information on individual Physician Quality Reporting quality measures or measures groups: (1) to CMS on their Medicare Part B claims, (2) to a qualified Physician Quality Reporting registry, or (3) to CMS via a qualified electronic health record (EHR) product. Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2011 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal to 1.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.

For more information visit the CMS website at: http://www.cms.gov/PQRI/

E-Prescribing Incentive Program

In 2009, CMS created an incentive program for eligible professionals to receive bonus payments for successfully using electronic prescribing systems. For 2011 and 2012, eligible professionals who are successful electronic prescribers may qualify to earn an incentive payment equal to 1.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period. For 2013, the incentive payment amount is reduced to 0.5%. Beginning in 2012, eligible professionals who are not successful electronic prescribers may be subject to a payment adjustment, or penalty. Specifically, for 2012 through 2014, if an eligible professional is not a successful electronic prescriber for the reporting period for the year, the PFS amount for covered professional services furnished by such professional during the year shall be less than the PFS amount that would otherwise apply by 1.0% for 2012, 1.5% for 2013, and 2.0% for 2014.

If an eligible provider chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the Medicare e-Prescribing Incentive Program. If an eligible provider chooses to participate in the Medicaid EHR Incentive Program, they can participate in Medicare e-Prescribing program simultaneously.

For more information, visit the CMS Website at: http://www.cms.gov/ERxIncentive