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    Physician Quality Reporting System (PQRS)

    The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time. By reporting on PQRS quality measures, individual EPs and group practices can also quantify how often they are meeting a particular quality metric. In 2015, the program began applying a negative payment adjustment to individual EPs who did not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule (MPFS) covered professional services in 2013. Those who report satisfactorily for the 2016 program year will avoid the 2018 PQRS negative payment adjustment.

    Some professionals may or may not be eligible to participate in PQRS reporting due to their billing methods. To determine if you are an eligible professional needing to report quality measures for PQRS, please click here [PDF].

    PQRS has several methods in which measure data can be reported. An individual eligible professional may choose from the following methods to submit data to CMS:

    • Medicare Part B claims
    • Qualified PQRS Registry
    • Direct Electronic Health Record (EHR)
    • Qualified Clinical Data Registry (QCDR).

    CMS has approved the ABFM as a Qualified PQRS Registry to submit PQRS measure group data to CMS on behalf of its Diplomates using the ABFM Performance in Practice Registry. You may use the PQRS Diabetes Module to collect and submit data to the Registry on a set of 20 unique, separate and distinct type 1 or type 2 diabetes mellitus patients of which a majority (11) is Medicare Part B FFS patients. The reporting period is January 1 – December 31, 2016 and all the patients must be between 18 and 75 years of age.

    To avoid the 2.0% payment adjustment in 2018, you must satisfactorily report data on quality measures for the 2016 reporting period of January 1 – December 31, 2016. Physicians working for more than one organization need to meet the reporting criteria for each tax identification number (TIN) under which they work during the 2016 PQRS program year to avoid the 2018 PQRS payment adjustment for each TIN.  

    Prior to beginning the PQRS Diabetes module, you must complete an online attestation form which gives the ABFM permission to transmit your data to CMS. Your individual National Provider Identifier (NPI) number and your Taxpayer Identification Number (TIN) are required for submission.

    Be certain to save the data collection templates while working through the activity. Approximately 3% of the registry's participants will be randomly selected for audit, so it is important that you maintain the templates that you have completed. Because you will be sending the ABFM de-identified data, these templates provide the only link between the data you send to us and the patients you have seen, which must be verified if you are selected for audit. Failure to provide the necessary information needed to conduct the audit will necessarily result in the inability to verify your data and may result in CMS applying the payment adjustment in 2018. We will forward your data to CMS in the first quarter of 2017. If you currently are participating in Family Medicine Certification, you may elect to continue the PQRS Diabetes module to receive Performance Improvement credit for your current stage (if you have not already completed a Performance in Practice Module [PPM] or an approved alternative Performance Improvement activity).

    For additional information, please contact the ABFM Support Center at 877-223-7437 or via email at help@theabfm.org.

    Frequently Asked Questions:

       2016 FAQ [256 KB]

    Registry Instructions:

       2016 Instructions [3 MB]

    Registry Template:

       2016 Template [447 KB]


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