Ask Able: Do my clinicians need to submit PQRS next year if they aren’t eligible for MIPS?


This is one of the most common questions that we are getting this week, so here’s the quick answer:

Regardless of your eligibility for the Merit-Based Incentive Payment System (MIPS), if you are an Eligible Professional under the Physician Quality Reporting System (PQRS) for the 2016 performance year, you will have to submit PQRS data by March 31st, 2017 (for Registry and QCDR reporting mechanisms) to avoid a negative payment adjustment in 2019. This will be the last time providers will submit data for PQRS.

2016 is the last performance year for PQRS, so you will no longer need to report for PQRS in future years. MIPS, which replaces PQRS starting in 2017, is part of the new Quality Payment Program under MACRA and combines requirements previously included in three separate programs administered by the Centers for Medicare and Medicaid Services (CMS): PQRS, the Medicare EHR Incentive Program (Meaningful Use), and the Value-Based Payment Modifier (VM).

These three programs will be sunset after their final payment adjustments are applied in 2018, and will be replaced by payment adjustments under the Quality Payment Program—for many providers, more specifically by MIPS. MIPS has four performance categories and a unified scoring system across those categories. The categories are: Quality, Cost, Advancing Care Information, and Improvement Activities. The first three performance categories generally align with PQRS, the Value-Based Payment Modifier, and Meaningful Use, respectively, but the requirements and scoring for the categories are significantly different from previous programs. Note that while the Advancing Care Information category under MIPS replaces the Medicare EHR Incentive Program, it does not affect the Medicaid EHR Incentive Program.

Read more about MIPS and its four performance categories here.

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Further reading:
6 ways to improve MIPS quality performance with the data you already have
MIPS exceptional performance bonus: how much could you earn?

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