New Rules for 2011 PQRS and eRx

  • When reporting PQRS group measures all 30 patients will need to have Standard Fee for Service Medicare as the primary or secondary insurance.
  • Also, the performance rate for each quality measure on the group or individual measures will need to be higher than 0%
  • You can earn the EHR Medicare incentive and also earn a bonus with PQRS reporting. If you earn the EHR incentive, you will not earn the eRx incentive. However, you will still need to report eRx in order to avoid the Medicare eRx penalties.
  • Very important: If reporting eRx through claims review the Remittance Advice notices from the Carrier/AB MAC to ensure you receive the N365 remark code for each G8553 submitted.
  • PQRS will continue to provide bonuses of 1.0 percent for 2011 and 0.5 percent for 2012 through 2014. If a provider doesn't report successful PQRS in 2013, there will be a -1.5% Medicare fee adjustment in 2015.
  • For reporting eRx on years 2011 and 2012, eligible providers will receive a payment equal to 1.0 percent of allowed charges. For reporting year 2013, providers will receive an incentive payment of 0.5 percent of allowed charges. Beginning in 2012, providers who do not satisfactorily report under the eRx Program will be subject to a 1.0 percent penalty. The penalty increases to 1.5 percent in 2013 and 2.0 percent in 2014.
  • For more detail please visit the CMS PQRI website at www.cms.gov/PQRS and the CMS EHR incentive site at www.cms.gov/EHRIncentivePrograms