PQRS stands for Physician Quality Reporting System. It is a Medicare (CMS) program started in 2006 (then called PQRI) and available to all “eligible professionals,” which includes all optometrists. Any licensed optometrist that bills Medicare can participate in the PQRS program. If you successfully participate in the PQRS program you will earn a small cash bonus, called the “PQRS incentive,” based on your annual Medicare payments. It is quite easy for any optometrist that participates in Medicare to qualify for the PQRS incentive. There is no sign-up or registration, you need only modify your procedure codes slightly. Don Sipola, O.D., has written an excellent instruction guide, PQRS for Dummies, to help you start participating.
In 2009 the Affordable Care Act modified the PQRS program in a number of ways. First, the PQRS bonus was extended through 2014. Second, it reduced the bonus amount from 2% of your Medicare collections in 2010 to 1% for 2011, and to 0.5% for 2012-2014. What that means in dollars is that, if your payments from Medicare for all of 2011 total, for instance, $60,000, and you successfully participate in PQRS, you will receive a $600 bonus payment (1% of $60,000), and for 2012 you’ll receive $300 (0.5% of 60,000). In addition, the Act added that there may be penalties if you do not participate by 2015. Because participation in PQRS is so simple, all optometrists that bill Medicare should read Dr. Sipola’s instructions and begin participating now. It is essentially free money.
The third thing the Affordable Care Act modifications did was add the ability to earn an “add-on” to your PQRS incentive payment equal to an additional 0.5% of your Medicare payments. But, unlike the PQRS program, qualifying for this extra 0.5% is not simple or inexpensive: it requires that you participate in a CMS approved “maintenance of certification” (MOC) process “more frequently” than is otherwise required by the certifying entity and that entity must certify that you have participated in the qualifying MOC program for one full year. But, unlike participating in PQRS, which is easy and essentially free, participating in a CMS approved MOC process is both costly and time consuming, especially in light of the meager bonus that can be earned, and there are no penalties associated with not participating.
Medicare has published an explanation of what “more frequently” means, which can be found at http://www.cms.gov/PQRS/Downloads/MOC_Guidance_Final1_2_3.pdf. Basically, it requires that you do more than is required by each portion of the qualifying entity’s MOC process. If one practice performance analysis is required every five years, you must do two. If two self-assessment modules are required every five years, you must do three. If an examination is required every 10 years, you must take it in nine years. In exchange for this extra effort, you can earn the 4extra 0.5% add-on. According to figures published by the AOA, optometrists that participated in PQRS in 2010 on average received $1168, with a median of $653. 2010 was a 2% year, meaning these payments are based on a 2% incentive payment for PQRS participation. Since PQRS reduces to 1% for 2011, it is reasonable to assume that the average and median payments in 2011 will drop to about one-half of the 2010 levels, and drop one-half again in 2012 when the payment is reduced to 0.5%. Since the MOC participation “add on” is 0.5%, using the AOA figures, the MOC enhancement will be worth, on average, about $275 for 2012 for those participating in a qualified MOC program for one full year prior to December 31, 2012. To earn that $275 you must incur the costs, in both time and money, to participate in an approved certifying entity’s MOC process more frequently than otherwise required. If you join a CMS approved MOC program in fiscal 2012, your first full year will be 2013, paid in the third or fourth quarter of 2014. The last year of payment for PQRS incentives and the “add-ons” for MOC is 2014.