Skip to Main Content

Analysis and Payment

Each year, the Physician Quality Reporting System (PQRS) incentive payment and the PQRS feedback report are issued through separate processes. PQRS feedback report availability is not based on whether or not an incentive payment was earned. 

Feedback Reports

Feedback reports will be available for every Taxpayer Identification Number (TIN) under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported at least one valid PQRS measure a minimum of once during the reporting period. PQRS participants will not receive claim-level details in the feedback reports. For information on the feedback reports and how to request them, review the  2013 PQRS Feedback Report User Guide.

Incentive Payments

Eligible professionals who satisfactorily report quality-measures data for services furnished during a PQRS reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period.

Below are the authorized incentive payment amounts for each program year:

  • 2010 PQRS – 2.0%
  • 2009 PQRS – 2.0%
  • 2008 PQRS – 1.5%
  • 2007 PQRS – 1.5% subject to a cap

The Affordable Care Act authorized incentive payment through 2014:

  • 2011 PQRS – 1.0%
  • 2012 PQRS – 0.5%
  • 2013 PQRS – 0.5%
  • 2014 PQRS – 0.5%

Sequestration and PQRS

As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, PQRS incentive payments made to eligible professionals and group practices have been reduced by 2%. This 2% reduction affected PQRS incentive payments for reporting periods that ended on or after April 1, 2013. All 2014 incentive payments are subject to sequestration.

Payment Process

Incentive payments for each program year are issued separately as a single consolidated incentive payment in the following year. Incentive payments are issued to the first valid group location listed under the TIN; or, for solo practitioners, to the first valid practice location listed under the TIN.

The Medicare claims-processing contractors (Carrier or A/B MAC) will make the payment electronically or via check, based on how the TIN normally receives payment for Medicare Part B PFS covered professional services furnished to Medicare beneficiaries. If a TIN submits claims to multiple Carriers or A/B MACs, each contractor may be responsible for a proportion of the TIN incentive payment equivalent to the proportion of Medicare Part B PFS claims the contractor processed during the applicable reporting period.

Note: If splitting an incentive across contractors would result in any contractor issuing a PQRS incentive payment less than $20 to the TIN, the incentive will be issued by fewer contractors than may have processed PFS from the TIN for the reporting period. The PQRS incentive payment can be offset by an outstanding debt for the TIN.

The incentive payment, with the remittance advice, will be issued by Carrier/MAC and identified as a separate payment under the PQRS. Medicare contractors will use the indicator of LE ("Levy") to indicate federally mandated payments. LE will appear in the PLB-03-1 segment of the 835. In an effort to further clarify the type of incentive payment issued LE will appear on the remit, along with a 4-digit code to indicate the type of incentive and reporting year.

Payment Questions

Once CMS begin distributing incentive payments for a particular program year and if your incentive does not arrive or the incentive payment amount does not match what is reflected in your PQRS feedback report, contact your Carrier or A/B MAC (visit the Help Desk Support page for contact information).  Note: The incentive amount may differ by a penny or two from what is reflected in your feedback report due to rounding.

Informal Reviews

Eligible professionals, designated support staff/vendors, and group practices who submit data for PQRS program can request to have an informal review of their PQRS reporting performance through the Communication Support Page.

An informal review may be requested if the feedback report reveals that the eligible professional or group practice did not earn the PQRS incentive payment when they believe they should have, or when they believe the payment amount was incorrect. Informal review requests for 2013 will be accepted from November 1, 2014 through February 28, 2015.

2014 PQRS

2014 Interim Feedback Dashboard User Guide 

The 2014 Interim Feedback Dashboard User Guide is designed to assist eligible professionals, and their authorized users, with accessing and interpreting the 2014 interim Dashboard data. The Dashboard allows organizations and eligible professionals (EPs) to log-in to a web-based tool and access their 2014 Physician Quality Reporting System (PQRS) data on a quarterly basis in order to monitor the status of claims-based individual measures. To view this document click on the following link: 2014 Interim Feedback Dashboard User Guides.

2014 PQRS Measure-Applicability Validation (MAV) Process for Claims and Registry-Based Reporting of Individual Measures

The following documents pertaining to the 2014 (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures are available in the 2014 PQRS Claims Measure Applicability Validation Documents zip file:

  • 2014 PQRS Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures – provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than nine PQRS measures or for fewer than three NQS domains, and how the MAV process will determine whether they should have submitted QDCs for additional measures.
  • 2014 PQRS Measure-Applicability Validation (MAV) Process Release Notes – the release notes for the changes occurring from the 2012 PQRS Measure-Applicability Validation (MAV) Process.
  • 2014 PQRS Claims-Based Measure-Applicability Validation (MAV) Process Flow – a chart that depicts the MAV Process for claims-based reporting.

The following documents pertaining to the 2014 (PQRS) Measure-Applicability Validation (MAV) Process for Registry-Based Reporting of Individual Measures are available in the 2014 PQRS Registry Measure Applicability Validation zip file:

• 2014 PQRS Measure-Applicability Validation (MAV) Process for Registry-Based Reporting of Individual Measures – provides guidance for those eligible professionals who satisfactorily submit via a Qualified Registry for fewer than nine PQRS measures or for fewer than three NQS domains, and how the MAV process will determine whether they should have submitted additional measures.
• 2014 PQRS Registry-Based Measure-Applicability Validation (MAV) Process Flow
– a chart that depicts the MAV Process for registry-based reporting.

2013 PQRS

2013 PQRS Feedback Report User Guide

A quick reference guide for understanding the 2013 PQRS Feedback Report has been posted on this page.  The Physician Quality Reporting System (PQRS) Feedback Report User Guide is designed to assist eligible professionals (EPs) and their authorized users with accessing and interpreting the 2013 PQRS feedback reports. To view this document click on the following link:  2013 PQRS Feedback Report User Guide.

2013 PQRS Incentive Payment User Guide

This document describes how the 2013 PQRS incentive payment was calculated for 1) individual eligible professionals (EPs), 2) self-nominated/registered group practices participating via the Group Practice Reporting Option (GPRO), and 3) EPs participating in PQRS through another program such as Medicare Shared Savings Program (MSSP), Comprehensive Primary Care Initiative (CPCI), or Pioneer Accountable Care Organizations (ACOs).  To view this document click on the following link: 2013 PQRS Incentive Payment User Guide. 

2012 PQRS eRx Experience Report

The following documents pertaining to the 2012 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Experience Report are available in the 2012 PQRS and eRx Experience Report zip file:

  • 2012 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Experience Report - summarizes the reporting experience of eligible professionals in these programs in 2012, historical trends, and preliminary results for the 2013 program year.
  • 2012 PQRS and eRx Incentive Program Release Appendix - provides tables and explains data and methods for the report.

A data brief highlighting participation in these programs in 2012 is also available.