PQRS

Background

The Physician Quality Reporting System (PQRS) is a voluntary reporting program that provides an incentive 
payment to identified eligible professionals who satisfactorily report data on quality measures for covered 
Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries 
(includes Railroad Retirement Board and Medicare Secondary Payer). 

Physicians who are incentive eligible for PQRS can receive an additional 0.5% incentive payment when 
Maintenance of Certification Program Incentive requirements have been met. This physician-only incentive will 
be paid at the same time as the 2013 PQRS incentive for those physicians who qualify. Physicians cannot 
receive more than one additional 0.5% Maintenance of Certification Program Incentive, even if they complete a
Maintenance of Certification Program in more than one specialty. 

The Centers for Medicare & Medicaid Services (CMS) suggests that physicians periodically review posted 
Maintenance of Certification Program Incentive materials on the CMS PQRS web site at 
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS to ensure they are 
informed of all program clarifications and updates. 

Purpose

This Fact Sheet provides steps for successful participation in the Maintenance of Certification Program 
Incentive. It also explains the role of the qualified Maintenance of Certification Program Incentive entity.

Steps for Successful Participation
STEP 1: Determine if you are able to participate. To be eligible for the Maintenance of Certification Program 
Incentive you must be a board-certified physician.
STEP 2: Meet the requirements for satisfactory reporting under PQRS for a 12-month reporting period as an 
individual eligible professional using either individual PQRS measures or measures groups and 
submitting the PQRS data via claims, a registry, or a qualified EHR, OR participate under the group 
practice reporting option (GPRO) for a 12-month reporting period.
STEP 3: Identify a Maintenance of Certification Program that has become qualified for purposes of the 2013
PQRS Maintenance of Certification Program Incentive. A list of qualified medical specialty boards or 
entities sponsoring a Maintenance of Certification Program for 2013 can be found on the CMS 
PQRS web site at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Maintenance_of_Certification_Program_Incentive.html. It is recommended that 
physicians who wish to participate in the 2013 Maintenance of Certification Program Incentive 
contact their specialty board or other applicable sponsoring entity for additional details on 
participation requirements.
STEP 4: After selecting a sponsoring organization for the Maintenance of Certification Program Incentive, 
you must more frequently than is required to qualify for or maintain board certification status:
• Participate in a Maintenance of Certification Program for a year, and
• Successfully complete at least one Maintenance of Certification Program practice assessment 
for such year that includes a survey of patient experience with care.


What Does “More Frequently” Mean?
Under section 1848(m)(7)(C)(i) of the Social Security Act, a “Maintenance and Certification Program” shall 
include and require a physician to do the following (referred to below as Parts I-IV). 

I. Maintain a valid, unrestricted medical license in the United States;
II. Participate in educational and self-assessment programs that require an assessment of what was 
learned;
III. Demonstrate through a formalized, secure examination, that the physician has the fundamental 
diagnostic skills, medical knowledge and clinical judgment to provide quality care in their respective 
specialty; and
IV. Successfully complete a qualified Maintenance of Certification Program practice assessment.

CMS has applied the “more frequently” participation requirements to Parts I-III of the Maintenance of 
Certification Program definition above. An eligible professional is required to participate more frequently than is 
required in at least one of the first two parts (Part II – III). For Part I, Physicians simply need to maintain a valid,
unrestricted license in the United States to meet the requirement for “more frequent” participation. The phrase 
“more frequently” may be interpreted differently by various CMS-qualified Maintenance of Certification 

Programs.
Part IV, successful completion of a qualified Maintenance of Certification Program practice assessment,  (THIS MEANS PQI)  must be done for each year the eligible professional participates in the Maintenance of Certification Incentive, regardless of whether or how often the physician is required to participate in a Maintenance of Certification Program to maintain board certification.

What is the Role of a Maintenance of Certification Program Entity?
Maintenance of Certification Program entities will manage the program as well as submit 2013 information by 
February 28, 2014 on behalf of physicians. A Maintenance of Certification Program has demonstrated to CMS 
what constitutes “more frequently” for the Maintenance of Certification Program itself and for the practice 
assessment for the specific Maintenance of Certification Program of the sponsoring organization.

The final list of Qualified Maintenance of Certification Program entities will be posted by mid-2013 on the 
PQRS section of the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Maintenance_of_Certification_Program_Incentive.html.

Resources 
Reference documents can be found under the downloads section on the CMS PQRS Maintenance of 
Certification Program Incentive website at http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/PQRS/Maintenance_of_Certification_Program_Incentive.html include:
• The Physician Quality Reporting System Maintenance of Certification Program Incentive 
Requirements of Self-Nomination for 2013
• Fully Qualified Maintenance of Certification Program Incentive Entities for 2013

Questions? 
Contact your qualified Maintenance of Certification Program with questions. Physicians will need to work with 
their selected Maintenance of Certification Program to ensure successful completion of the 
Maintenance of Certification Program Incentive participation requirements.
If your entity is unable to answer your questions, please contact the QualityNet Help Desk at 866-288-8912 (available 7 a.m. to 7 p.m. CST 
Monday through Friday, TTY 877-715-6222) or via e-mail at qnetsupport@sdps.org.