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2008 PQRI Statutory Authority On December 29, 2007, the President signed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), which authorized the continuation of the Physician Quality Reporting Initiative (PQRI) for 2008 and 2009. The financial incentive for eligible professionals who successfully report the designated set of quality measures is 1.5% of total allowed charges for covered services payable under the Medicare Physician Fee Schedule (PFS) during the reporting period. Financial incentives earned for 2008 reporting will be paid in mid-2009 from the Federal Supplementary Medical Insurance (Part B) Trust Fund. The 1.5% financial incentive and its funding source are the same as for 2007. PQRI 2008: MMSEA allows program flexibility for 2008 by authorizing CMS to establish alternative mechanisms to previously established claims-based reporting of PQRI quality data. MMSEA provisions require alternative reporting periods and alternative criteria for satisfactorily reporting quality measures data through medical registries and reporting measures groups. In 2008, eligible professionals may earn an incentive payment of 1.5 percent of their total allowed charges for PFS covered professional services furnished during the respective alternative reporting periods based on data submitted via these mechanisms. While TRHCA established a cap on incentive payments for 2007, based on an average per measure payment amount, there is no cap on incentive payments under MMSEA for 2008 and 2009. The alternative reporting criteria and reporting periods under MMSEA for measures groups and registry-based reporting were established effective April 15, 2008. The "Downloads" section below contains the document establishing those alternative reporting periods and alternative reporting criteria. The provisions of this document do not apply for the PQRI in 2009. Requirements for 2009 PQRI will be established at a later time. Note that physicians and eligible professionals still have the opportunity to begin participating in the 2008 program, and should review the "2008 PQRI: Establishment of Alternative Reporting Periods and Reporting Criteria" document for more information about the dates for which reporting can occur. 2008 PQRI Regulations The PQRI provisions of the MPFS 2008 Final Rule (1) announced provisions for measure development and consensus-organization approval and (2) identified 119 quality measures, including 2 structural measures, for 2008 PQRI. One structural measure conveys whether a professional has and uses electronic health records and the other electronic prescribing. A summary of the PQRI provisions in the MPFS 2008 Final Rule is available in the "Downloads" section below. To view the entire MPFS 2008 Final Rule or its precursor, the MPFS 2008 Notice of Proposed Rulemaking (NPRM), click on the relevant link in the "Related Links Inside CMS" section below. The comments that CMS received in response to the MPFS 2008 NPRM are also available by clicking on the relevant link in the "Related Links Inside CMS" section below. 2007 PQRI Statutory Authority On December 20, 2006, the President signed the Tax Relief and Health Care Act of 2006 (TRHCA), which initially authorized the PQRI. To view the legislative language, see the "Downloads" section below. 2007 PQRI Program Instructions During implementation of the 2007 PQRI, CMS issued two transmittals: CR 5558 – Program Overview: 2007 Physician Quality Reporting Initiative and CR 5640 – Physician Quality Reporting Initiative (PQRI) Coding & Reporting Principles. These transmittals may be viewed by clicking on the relevant link in the "Related Links Inside CMS" section below.
Page Last Modified: 09/12/2008 11:10:49 AM
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