Understanding the Physician Quality Reporting Initiative

Want to get 2% back on your Medicare services? Consider the Physician Quality Reporting Initiative, referred to as PQRI for short. What is the PQRI? The 2006 Tax Relief and Health Care Act established a voluntary quality reporting program for physicians. Under the program, eligible professionals who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries receive incentive payments. Each year, the Centers for Medicare and Medicaid Services (CMS) implements the PQRI through an annual rulemaking process published in the Federal Register. Are you eligible? Click here for a list of eligible professionals . For 2009, the definition has been expanded to include audiologists. How does it work? Eligible professionals (EPs) do not have to enroll in the PQRI. You simply report the quality measures. There are two ways to do so. First, you can report quality measures data through claims. If you choose this method, just report the appropriate quality data codes on service lines of Medicare Part B Physician Fee Schedule (PFS) professional-services claims. Second, you can report quality measures data to a qualified registry. If you participate in a qualified registry, you should expect to receive more information from the registry on how to participate. For 2009, there are a total of 153 quality measures (52 of them are new). Most measures can be reported through claims submission or through a PQRI registry. However, unlike in 2008, in 2009 a subset of the quality measures is reportable only through registries. Note that CMS is testing electronic health record (EHR) data submission in cooperation with EHR vendors. At this time, however, there is no PQRI incentive payment available through EHR-based data submission. How much is the incentive? For 2009, the incentive is 2% of the eligible professional’s estimated total Medicare Part B Physician Fee Schedule (PFS) allowed charges. For more information For details, please visit the CMS PQRI web site , or see the attached data sheet .

Want to get 2% back on your Medicare services? Consider the Physician Quality Reporting Initiative, referred to as PQRI for short.

What is the PQRI?

The 2006 Tax Relief and Health Care Act established a voluntary quality reporting program for physicians.

Under the program, eligible professionals who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries receive incentive payments.

Each year, the Centers for Medicare and Medicaid Services (CMS) implements the PQRI through an annual rulemaking process published in the Federal Register.

Are you eligible?

Click here for a list of eligible professionals. For 2009, the definition has been expanded to include audiologists.

How does it work?

Eligible professionals (EPs) do not have to enroll in the PQRI. You simply report the quality measures. There are two ways to do so.

First, you can report quality measures data through claims. If you choose this method, just report the appropriate quality data codes on service lines of Medicare Part B Physician Fee Schedule (PFS) professional-services claims.

Second, you can report quality measures data to a qualified registry. If you participate in a qualified registry, you should expect to receive more information from the registry on how to participate.

For 2009, there are a total of 153 quality measures (52 of them are new). Most measures can be reported through claims submission or through a PQRI registry. However, unlike in 2008, in 2009 a subset of the quality measures is reportable only through registries.

Note that CMS is testing electronic health record (EHR) data submission in cooperation with EHR vendors. At this time, however, there is no PQRI incentive payment available through EHR-based data submission.

How much is the incentive?

For 2009, the incentive is 2% of the eligible professional’s estimated total Medicare Part B Physician Fee Schedule (PFS) allowed charges.

For more information

For details, please visit the CMS PQRI web site, or see the attached data sheet.

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