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The 2007 Physician Quality Reporting Initiative (PQRI) is applicable only to services furnished on or before December 31, 2007. For information about 2008 PQRI, please click on the Overview tab on the navigation bar at left. 2007 PQRI General Information addresses four topics identified below. For educational resources and implementation tool kit for the 2007 PQRI, please click on the "2007 PQRI Educational Resources and Tool Kit" tab on the navigation bar at left. Program Overview: Statutory and Regulatory Provisions Eligible Professionals Measures/Codes Reporting, Analysis and Payment _____________________________________ Program Overview: Statutory and Regulatory Provisions On December 20, 2006 the President signed P.L. 109-432, the Tax Relief and Health Care Act of 2006 (TRHCA). Division B, Title I, Section 101 of Title I of TRHCA authorized the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI). PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully reported PQRI quality measures on claims for dates of service from July 1 through December 31, 2007, may earn an incentive, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services furnished July 1 through December 31, 2007. The TRHCA specifically authorized CMS to implement the 2007 PQRI by program instructions or other means. On March 9, 2007, CMS released Change Request (CR) 5558 - Program Overview: 2007 Physician Quality Reporting Initiative. To view CR5558, see the "Related Links Inside CMS" section below. On May 18th, 2007, CMS released Change Request (CR) 5640- Physician Quality Reporting Initiative (PQRI) Coding & Reporting Principles. To download CR5640, see the "Related Links Inside CMS" section below. ______________________________________ Eligible Professionals Under the 2007 PQRI, covered professional services are those paid under the Medicare Physician Fee Schedule. To the extent eligible professionals furnished services that were paid under the Medicare Physician Fee Schedule, those services were eligible for PQRI. To view a listing of professionals statutorily eligible to participate in PQRI, see the "Related Links Inside CMS" section below. ______________________________________ 2007 PQRI Measures/Codes The list of 74 quality measures meeting TRHCA requirements for use in the 2007 PQRI was published by CMS on April 1, 2007. This 2007 PQRI Quality Measures List is available in the "Downloads" section below. The final, detailed 2007 PQRI Measure Specifications were posted prior to the July 1, 2007, start date of PQRI reporting, and are available in the "Downloads" section below. ______________________________________ 2007 PQRI Reporting, Analysis and Payment Eligible professionals participated in the 2007 PQRI by reporting the appropriate quality-measure data on claims submitted to their Medicare claims processing contractor for dates of service July1 through December 31, 2007. In order to satisfy the PQRI requirements and earn the financial incentive, certain reporting thresholds must be met. If no more than three 2007 PQRI quality measures were applicable to services furnished by an eligible professional, each such measure must have been reported in at least 80% of the cases in which the measure was reportable. When four or more measures were applicable to the services furnished by an eligible professional, the 80% threshold must have been met on at least three of the measures reported. 2007 PQRI Feedback Reports Practices with 2007 PFS professional service paid charges and at least one participating EP (with individual National Provider Identifier or NPI) with one or more valid quality-data code (QDC) submissions will have feedback reports accessible through the PQRI Portal on the QualityNet website. To assist EPs in interpreting these reports, a "2007 PQRI Feedback Report User Guide", is available in the Related Links Outside CMS section below. 2007 PQRI- Validation As required by the TRHCA, the 2007 Physician Quality Reporting Initiative (PQRI) includes validation processes. The determination of satisfactory reporting, as defined by statute, will itself serve as a general validation because the analysis will assess whether quality-data codes are appropriately submitted in a sufficient proportion of the instances when a reporting opportunity exists. In addition, for those professionals who achieve a reporting rate at or above 80% for each of fewer than three PQRI measures, a measure-applicability validation process will determine whether they should have submitted quality-data codes for additional measures. For information on how the 2007 PQRI measure-applicability validation will be implemented, see the "Downloads" section below. 2007 PQRI Incentive Payment Lump-sum incentive payments for satisfactory 2007 PQRI reporting were issued either electronically or via check in July 2008 by the Carrier/MAC to the Taxpayer Identification Number (TIN) under which claims were paid - i.e. Physician Fee Schedule (PFS) charges for the period show up on 1099 IRS form for that TIN. Payments to TINs billing through multiple Carriers/MACs may be split among several Carriers/MACs. To assist EPs in understanding the payment calculation, "A Guide for Understanding the 2007 Physician Quality Reporting Initiative (PQRI) Incentive Payment," is available in the Downloads section below. Questions about whether an incentive payment was issued to a participant can be directed to the Carrier/MAC. Telephone numbers are available from the "Provider Center Toll-free Numbers Directory" (see the Related Links Inside CMS section below).
Page Last Modified: 08/28/2008 9:50:37 AM
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