Q: What is the difference between PQRI, PQRS and MOC:PQRS?
A: All are part of the Centers for Medicare and Medicaid Services' (CMS) program on Physician Quality Reporting.
  • The Physician Quality Reporting System (PQRS), formerly known as Physician Quality Reporting Initiative (PQRI) is a reporting program that provides an incentive payment to eligible professionals who satisfactorily report data on quality measures, and a payment adjustment to physicians who do not satisfactorily report data on PQRS measures for 2014. Physicians who successfully meet the criteria for PQRS reporting in 2014 will receive an incentive payment equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule allowed charges for covered professional services furnished during the reporting period. Physicians who do not meet the requirements for the 2014 PQRS program year will be subject to a negative 2% payment adjustment to their Medicare PFS amount for services provided in 2016.

  • MOC:PQRS offers eligible physicians who have satisfactorily submitted data under PQRS the opportunity to earn an additional incentive of 0.5% for participating in a CMS-qualified Maintenance of Certification program "more frequently" than is required to qualify or maintain board certification. The "more frequently" requirements are defined by the Boards in terms of their own MOC requirements and cycle times.

Q: My specialty Board isn't on the list, can I still participate in MOC: PQRS reporting?
A: You can participate in CMS Physician Quality Reporting (PQRS) but not MOC: PQRS Reporting for 2014. MOC: PQRS reporting is only available to physicians whose certifying Boards have gone through a qualifying process through CMS. Sixteen ABMS Boards have become fully qualified in 2014.

Q: What is the Incentive Payment Structure for 2014 PQRS?
A: Individuals EPs who meet the criteria for satisfactory submission of PQRS quality measures data via one of the reporting mechanisms will qualify to earn the incentive payment equal to 0.5%of their total estimated Medicare Part B PFS allowed charges for covered services furnished during the same reporting period. For more information about the PQRS incentive payments visit the analysis and payment web page. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html

Q: What is the Adjustment Payment Structure for 2014 PQRS?
A: EPs who do not satisfactorily report data on quality measures for covered professional services during the 2014 PQRS program year will be subject to a negative 2% payment adjustment to their Medicare Part B PFS amount for services provided in 2016. For more information about PQRS payment adjustments visit the Payment Adjustment Tip Sheet for additional information at the following web page http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014PQRS__Avoiding2016PQRS-PaymentAdjustment_F03-27-2014.pdf

Q: What is MAV?
A: Measure-Applicability Validation (MAV) is a process applied by CMS as part of the PQRS program to individual EPs (reporting via claims-based or registry-based) and group practices (reporting via registry-based) that report less than nine measures, or nine or more measures with less than three NQS domains to determine if there were related measures that could have been reported.

Q: What is the Impact of MAV?
A: The MAV process determines PQRS incentive eligibility and payment adjustment for reporting individual EPs (reporting via claims-based or registry-based) and group practices (reporting via registry-based).

Q: For the patient survey requirement, what is meant by institutional or departmental level surveys?
A: Many hospitals and health care institutions routinely conduct patient surveys on either a scheduled or rolling basis—sharing the results with physicians and staff in an effort to identify strengths and areas for improvement. If you, your department or division participated in this type of survey in 2014, it will count toward meeting the requirements for MOC:PQRS, even if the results were not specific to you. If, in 2014, you have participated in a patient experience of care survey that is specific to you (e.g. through your specialty Board or society), that also counts. Another option would be to use the survey module available in this application. Please keep in mind that CMS survey requirements may not satisfy your Board's MOC requirements.

Q: Do I need to provide anything extra to my Board to prove I am fulfilling the "more frequent" requirements?
A: Not unless specifically requested. CMS requires each qualified Board to validate physician compliance with the requirements of MOC: PQRS to the best of its knowledge and to audit a percentage of the participants on an annual basis. Since MOC: PQRS is a federal program, you also may be audited by CMS or other legal entities. Your attestation statements within this application serve as initial record of participation and will be maintained by your Board and available to CMS. If you are selected for audit, you may be asked to provide additional documentation to support your attestation (e.g. CME certificates, patient experience of care surveys, or documents verifying participation in Part IV activities) and the consequences will be determined by the rules and regulations of the auditing organization (e.g. Member Board, CMS). Otherwise, your Board will continue to track your progress in MOC via their usual monitoring schedule.

Q: Who issues the MOC:PQRS payment? When?
A: All payments come from CMS. For those physicians that qualify, CMS will issue the MOC: PQRS incentive payment at the same time as the PQRS incentive payment (for 2012 reporting, PQRS payments were issued in September 2013). If you fail to qualify for the PQRS incentive, you will not receive the MOC: PQRS incentive. Registration fees for MOC: PQRS tools will not be refunded if you do not qualify for the 0.5% incentive payment from CMS. CMS contact information can be found http://www.cms.gov/About-CMS/Agency-Information/ContactCMS/index.html

Q: If I am certified in more than one specialty can I receive more than one incentive payment?
A: No. Physicians cannot receive more than one additional 0.5% incentive even if they complete a Maintenance of Certification Program in more than one specialty.

Q: Where can I find more information related to the 2014 MOC:PQRS Reporting Requirements?
A: Questions related to the 2014 MOC:PQRS Reporting requirements need to be submitted to the CMS help desk.

Q: Where can I find more information regarding the PQRS measures listed for my Board?
A: Questions related to PQRS Measures need to be submitted directly to the appropriate ABMS Board.

Q: Where can I obtain technical support?
A: Technical questions related to the MOC Matters platform need to be submitted to CECity technical support services.