PQRS Medicare EHR Incentive Pilot: How it Works

Eligible professionals (EPs) participating in the Medicare EHR Incentive Program can satisfy the Meaningful Use requirement to report clinical quality measures (CQMs) to CMS by reporting them through the Physician Quality Reporting System (PQRS) Medicare EHR Incentive Pilot. So what exactly is required of providers to participate in the Pilot?

The Pilot program uses specific Physician Quality Reporting EHR measure specifications. Eligible professionals (EPs) participating in the Pilot are required to submit information on the three core Stage 1 meaningful use clinical quality measures. If the denominator for one or more of these core measures is zero, the EP must report on up to three alternate core measures. EPs must also report on three additional menu clinical quality measures available for the Medicare EHR Incentive Program. Please refer to the 2013 Physician Quality Reporting System-Medicare EHR Incentive Pilot Quick-Reference Guide for a complete list of the core, alternate core and additional measures available for reporting.

EPs who seek to participate in the Pilot must also participate in PQRS through submission of specific Physician Quality Reporting EHR measures, but can focus on the same sample of beneficiaries for both programs. The PQRS program looks at individual patient data using a continuity of care document (CCD), while the Meaningful Use programs currently look at aggregate patient data for trends. Thus, EPs participating in the Pilot program submit these two different types of data on the same sample of beneficiaries; they report a specialized CCD on individuals known as Quality Reporting Document Architecture (QRDA) files for PQRS and submit EHR aggregate extensible markup language (XML) files for Meaningful Use.

To submit these data files to CMS, EPs have two options for PQRS and Meaningful Use reporting, as follows:

  1. EHR Direct: With EHR Direct, files are submitted by the EP directly from the EHR. EPs report both PQRS and Meaningful Use Quality Measures by submitting the files to the QualityNet Portal using their CMS Identity Management and Authentication system (IACS) account. In order to submit PQRS measures via EHR Direct, EPs must have an EHR that is capable of submitting EHR-derived data direct to CMS. A challenge for many practices, there were only 24 EHR vendors that successfully tested for EHR Direct with CMS for 2013 PQRS EHR Direct reporting.
  2. Data Submission Vendor: With this option, the EP's EHR vendor submits the data on the EP's behalf. There is no need for the practice to go through the setup of an IACS account. In order to use this option, EPs must have a qualified data submission vendor.

Want to learn more? Download a free PQRS Medicare EHR Incentive Pilot program fact sheet.