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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 the PQRI as it relates to services furnished after December 31, 2007, 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 Incentive Payment _____________________________________ 2007 PQRI - 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 PQRI. PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who satisfactorily reported PQRI quality measures on claims for dates of service from July 1 through December 31, 2007, qualified to 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. The "Tax Relief and Health Care Act of 2006 Section 101" is available in the "Downloads" section below. 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 view CR5640, see the "Related Links Inside CMS" section below. ______________________________________ 2007 PQRI - 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, click on the "Eligible Professionals" link to the left. ______________________________________ 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 Incentive 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 2007 PQRI - Feedback Reports Are Available by TIN. If you reported PQRI quality measures for 2007 (at least one valid quality data code), you may access your 2007 PQRI Feedback Report through the PQRI Portal on the Quality Net website. A link to the Quality Net website may be found in the "Related Links Outside CMS" section below. Once on the Quality Net website, click on "PQRI" from the dropdown menu under the "Physician Offices" tab. Once on the "PQRI" page, go to "PQRI Portal" located on the top right of the page and click on "2007 Feedback Reports." A self-service look-up tool is available on the PQRI Portal which allows an eligible professional at the Tax Identification Number (TIN) level to see if their 2007 PQRI Feedback Report is available. Once in the PQRI Portal, go to the "Verify TIN Report Portlet" which is located at the bottom left of the page. Enter the TIN and a message appears that indicates if a 2007 PQRI Feedback Report is or is not available. To access your feedback report, if one is available, you must first register for access through a CMS security system known as the Individual Authorized Access to CMS Computer Services (IACS) to receive an IACS user ID and Password. The IACS user ID and Password are needed to access your feedback report.
To register for an IACS user ID and Password, you will need to determine if you should register under the "Individual Practitioner" role or as an "Organization." Register as an "Organization" if you are a group practice which receives Medicare payments on behalf of its members, or if you are a solo eligible professional who will use one or more employee(s) to access the feedback reports. Note that each "Organization" must designate the individual who will register in IACS on the Organization's behalf. Up to two individuals will be able to access the feedback reports for each organization. One 2007 PQRI feedback report will be prepared for each taxpayer identification number (TIN). The group practice will be responsible for sharing National Provider Identifier (NPI) level information with the appropriate professionals within the group practice. Further information on how to register for IACS, as well as IACS Quick Reference Guides can be found by clicking on the "Individuals Authorized Access to the CMS Computer Services (IACS)" link in the "Related Links Inside CMS" section below. MLN articles that outline the steps for accessing the 2007 Feedback Reports can be found in the "2007 PQRI Educational Resources" link to the left. The "2007 PQRI Feedback Report User Guide" is available on the Quality Net website, by clicking on "PQRI" from the dropdown menu under the "Physician Offices" tab. This guide, which contains information about how to register for and access the feedback reports, is available by clicking on "2007 Feedback Reports" under the "PQRI Portal" located on the top right of the "PQRI" page. Please note, the Quality Net website may be down for maintenance or other reasons. If eligible professionals encounter this issue, we advise them to try accessing the site at a later time. 2007 PQRI- Validation As required by the TRHCA, the 2007 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 "PQRI Measure Applicability Validation Process" document in 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. A one-page "Quick-Reference Guide to 2007 PQRI Incentive Payment Support" is available to assist EPs with contacting the appropriate Help Desk and linking to reference documents. See 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" in the "Related Links Inside CMS" section below.
Page Last Modified: 12/08/2008 1:38:45 PM
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