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Are you Eligible to Participate in PQRS?

The CMS Physician Quality Reporting System (PQRS) is a program in which eligible professionals (EPs) report data on quality measures for covered Physician Fee Schedule (PFS) services provided to Medicare Part B Patients. EPs are encouraged to satisfactorily report data on quality measures for covered professional services through incentive payments (concluding in 2014) and payment adjustments for not satisfactorily reporting data on quality measures (starting in 2015).

EPs will be subject to a payment adjustment in 2015 if they do not satisfactorily report data on quality measures in 2013.


Are you an eligible professional?

PQRS Eligible Professionals provide services which are paid under or are based on the Medicare Physician Fee Schedule (PFS); those services are eligible for PQRS incentive payments for satisfactory 2013 participation.

Are you an eligible professional, but NOT able to participate?

Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate if any of the following circumstances apply:

  • Professionals who provide Part B services, but bill Medicare at a facility or institutional (Part A) level.
  • Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services.
  • Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing, cannot participate, since the CAH does not include the individual provider NPI on their Institutional (FI) claims.


For Eligible Professionals Able to Participate: How to Get Started!

Visit ‘How to Get Started’ on the CMS website for instructions on how to participate or visit the MediSYS website at


Media Contact:
Kelly Cannon                                                        
[email protected]