Deadline to Avoid PQRS Penalty Extended to Oct. 18

October 15, 2013

The deadline to avoid a 1.5% Medicare penalty in 2015 for not participating in the Physician Quality Reporting System (PQRS) this year has stretched out from today to Friday, October 18, according to the Centers for Medicare & Medicaid Services (CMS).

The American Medical Association (AMA) announced today that CMS extended the deadline "based on AMA advocacy efforts." The association said it will seek an even longer extension, "but it may not happen due to the government shutdown."

In PQRS, individual physicians and group practices tell Medicare how they are doing on various measures of clinical quality, such as the percentage of patients aged 50 through 75 years who received the appropriate colorectal cancer screening. Their reward is a small bonus. Failure to participate in PQRS this year, however, triggers a 1.5% reduction in Medicare reimbursement in 2015.

Physicians can dodge the penalty by qualifying in 2013 for a PQRS bonus of 0.5%. The reporting deadline is February 28, 2014, for physicians who submit performance data through Medicare claims or their electronic health record (EHR) system. Physicians submitting data through a patient registry have until the end of March 2014.

There are 2 easier ways to avoid the 2015 penalty, but they won't earn anyone a bonus. The first is to submit 2013 performance data early next year for just one quality measure or group of measures.

The second escape hatch is asking CMS by October 18 to calculate a PQRS grade based on Medicare claims submitted in 2013. Information on how individual physicians can request this "administrative claims" option is available on the CMS Web site.

Group practices that want CMS to derive their quality score from Medicare claims also can read up on this and other options on the agency Web site.

Groups with more than 100 physicians and other eligible clinicians who fail to participate in PQRS this year face not only a 1.5% Medicare penalty under that program in 2015, but also an additional 1% pay cut under the Value-Based Payment Modifier (VBPM) program. These large groups can request the administrative-claims option by October 18 to steer clear of both penalties.

In an email last Friday, CMS said the government shutdown would prevent it from updating its Web site to reflect the deadline extension from October 15 to October 18. However, the agency's so-called Enterprise Portal, where physicians can get started with PQRS, states that registration for the administrative-claims option is open until this Friday.

More information on the PQRS and VBPM programs can be found on the CMS Web site.

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