CMS Pub. 100-22, ch. 3, § 20

(PQRS)

(Rev. 11, Issued: 03-26-13, Effective: 06-25-12, Implementation: 06-25-12)

The Medicare contractors will receive recurring update notification change requests for PQRS incentive

payments. For additional information on this program, see Chapter 1 of this manual.

Contractors shall make the PQRS incentive payments to a group practice, or individual for a private practice,

associated with the Tax Identification Number (TIN) identified on the PQRS Incentive Payment file. There

will be an annual payment file, developed by a CMS specialty contractor, containing the following

information:

• Eligible Professional (EP) Contractor Number

• EP Tax ID Number

• EP Incentive Amount

• Incentive Report Start Date

• Incentive Report End Date

The CMS specialty contractor shall include a header record on the payment file to identify the type of

incentive file and reporting period. PQ denotes PQRS. The file transfer process is as follows: (1) The

specialty contractor shall transmit the Incentive Payment file to the CDS and HP EDC in Extended Binary

Coded Decimal Interchange Code (EBCDIC); (2) MCS shall segregate the Incentive Payment file

MAC/carrier workload number and load into the appropriate instance of MCS; (3) Contractors shall retrieve

the file upon direction from CMS after the file is available at the datacenter.

The time frame that Medicare contractors have for completing the PQRS Incentive payments is

approximately thirty calendar days. The exact payment beginning and end dates will be in the recurring

update notification. There are 4 possible payment months each year: May, August, September, and October.

CMS shall add, at its discretion, up to (1) one extra payment cycle per payment year. The Carrier/MACs will

be notified via a recurring update notification change request which month the respective incentive

payments shall be made. Also, there is the potential for a supplemental payment file that could be provided

at a later date, if CMS determines a need for making a supplemental payment. If needed, a supplemental

payment would be made in one of these 4 payment months.