Medicare Physician Quality Reporting System (PQRS)

Physical therapists who bill Medicare for outpatient physical therapy services in private practice settings (using the 1500 claim form or 837-P) can obtain a 0.5% bonus payment in 2014 if they report on quality measures under a program, referred to as the "Physician Quality Reporting System." The Affordable Care Act makes a number of changes to the Physician Quality Reporting System, including authorizing incentive payments through 2014 and requiring a penalty, beginning in 2015 for professionals who do not satisfactorily report.

The Centers for Medicare and Medicaid Services finalized the use of the calendar year 2013 and 2014 reporting period to inform the 2015 and 2016 payment adjustments respectively. Eligible professionals, including physical therapists that do not satisfactorily report data on quality measures for the January 1, 2014-December 31, 2014 reporting period, will be subject to the 2.0% adjustment in their fee schedule amount in 2016.

PQRS Update

Listen to new podcasts on 2014 PQRS updates that cover several measure updates as well as provide a summary of the 2014 changes to the physician quality reporting system for 2014.

Getting Started with PQRS

How Do I Choose My Reporting Method?

Therapists should choose a reporting method annually, at the beginning of the calendar year, and may choose to report by 1 of 2:

  • Claims
  • Registry
Learn more.

How Do I Select My Measures?

Therapists should select measures annually, based on their reporting method and their patient population:

  • Individual measures
  • Measures groups (registry only)
  Learn more.

What Is The Reporting Process?

Unlike the functional limitation reporting program, PQRS reporting is tied to the submission of specific CPT codes, typically 97001 and 97002. Therapists will only submit data on those visits in which they bill an eligible CPT code.

Learn more.

How Do I Know If I am Successful?

Therapists should utilize feedback reports to determine their reporting success; these should monitored throughout the year.

  • CMS feedback reports through QualityNet
  • Registry feedback reports (if applicable)
  Learn more.

2014 Updates

General Information

2014 Updates

Related Resources

Discussion Forum

  • PQRS Discussion Forum

    The PQRS discussion forum in APTA Communities is a chance for members to get answers to frequently asked questions and share experiences.

Postacute Care Compliance Seminar 124x237