PQRS & Measurement

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released updates to the Quality Payment Program (QPP) as part of the 2025 Physician Fee Schedule (PFS). These updates are also available in the QPP Resource Library. Established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the QPP provides tools and resources for Medicare providers.

Beginning January 1, 2022, clinical social workers (CSWs) will become eligible to participate in Medicare’s Quality Payment Program (QPP). NASW advocated for the inclusion of CSWs in the QPP and are pleased that they are now eligible.

In December 2014, clinical social workers who are Medicare providers may have received letters from the Centers for Medicare and Medicaid Services (CMS) which informed them of a penalty in 2015 for not using the Physician Quality Reporting System (PQRS) in 2013. PQRS was established by the Tax Relief and Health Care Act of 2006 (TRHCA). It is a voluntary quality reporting program for Medicare which was first implemented during the period of July 1, 2007 through December 31, 2007.

NASW would like hear from clinical social workers who have a certificate in applied behavioral analysis and treat patients who have the diagnosis, Autism Spectrum Disorder. 

Clinical social workers who are Medicare providers should participate in the 2013 Physician Quality Reporting System (PQRS).  Participation increases practice revenue by .5 percent and avoids a 1.5 percent penalty in 2015 for not using measures in 2013.