The Centers for Medicare & Medicaid Services (CMS) oversees the Physician Quality Reporting System and e-Prescribing Incentive Programs. These programs manage incentive payments for eligible professionals who satisfactorily report on clinical quality measures for covered professional services furnished to Medicare beneficiaries.
Physician Quality Reporting must relate to Medicare Physician Fee Schedule (MPFS)-covered professional services furnished in one of two reporting periods during the applicable program year: a 12-month reporting period January 1 through December 31, and a six-month reporting period July 1 through December 31.
In 2007, the Physician Quality Reporting System and e-Prescribing Incentive Programs began with 74 quality measures available for reporting individually through claims submissions. Each subsequent year, CMS has expanded the Physician Quality Reporting System and e-Prescribing Incentive Programs through the rule making process to include additional measures and alternative reporting options including measures groups, registry submissions, EHR submissions and the Group Practice Reporting Option.
Selected program measures are maintained and managed by an organization CMS qualifies as “measure owners” or “measure developers.” Each measure owner/developer performs a literature search, gap analysis and measure harmonization activities, as well as solicits expert feedback to develop, complete annual measure maintenance and seek NQF endorsement. CMS strongly prefers including NQF endorsed measures in measure reporting programs.
When a measure is proposed in the MPFS Rule to be included in the Physician Quality Reporting System and e-Prescribing Incentive Programs, there are requirements and expectations for the measure owners/developers in order to finalize these measures for inclusion in the program. After the measures are included in Physician Quality Reporting System and e-Prescribing Incentive Programs, there are additional ongoing requirements and expectations for measure owners/developers to maintain their measures in the program.