Do you submit PQRS codes for Medicare reimbursement?

If the answer is yes, and you are an LCSW, Clinical Psychologist or Clinical Psychiatrist, you no longer have to. 

CMS (finally!) confirmed to me last week that since the PQRS program was "sunset" on 12/31/2016, PQRS codes no longer apply towards reimbursement adjustments. The new program in MACRA, called MIPS (Merit-Based Incentive Payment System), has a quality measurement component that accounts for a large portion of a provider's MIPS rating. This quality measurement for all intents and purposes is PQRS. 

However, only certain providers are eligible for MIPS participation in 2017 & 2018. They are mostly primary care doctors, hospitals, etc. Everyone else is ineligible, including mental health professionals in private practice. Only eligible providers must submit data for MIPS, while everyone else does not over the initial phase of '17 & '18. 

This could be short-lived though, as Medicare accepting mental health professionals could become eligible starting in 2019. There are exemptions in place though, so even then a provider may not have to worry. It's important though to know if you're eligible, so you don't face negative reimbursement adjustments down the road. 

JG