How to get started with PQRI

Select the measure or measures group you intend to report on. How? First, check your specialty website for help in selecting measures

Medicare had two recent Open Door Forum calls with specialty societies recently:

http://www.cms.hhs.gov/PQRI/04_CMSSponsoredCalls.asp#TopOfPage

9/23/08 call was with American Gastroenterological Association

There is a PowerPoint discussion of measures they suggest are applicable.

9/24/08 call was with American Optometric Association. There is a PowerPoint presentation related to Optometrists

American College of Surgeons has information on their website for surgeons

http://www.facs.org/ahp/pqri/

Check your medical society/association for suggestions for your specialty.

No help from your society?  What do you need to download from the PQRI website? There’s no shortcut then.  From this page, download the measures

http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage

2009 PQRI Quality Measures List

2009 PQRI Measure Specifications Manual and Release Notes (Zip file)

Look at: 2009_PQRI_MeasureSpecificationsManual_120909.pdf

Careful printing!  It is 442 pages.

Measures groups

What is a measures group?  A group of measures related to a single disease process. There are eight measures group in 2009.

•    Download the measures group

2009 Measures Groups Specifications Manual and Release Notes

Getting Started with 2009 PQRI Reporting of Measures Groups

Look at: 2009_PQRI-MeasuresGroups_Specifications_Manual_120808.pdf

This is a 75 page document.  

•    Circle any that are relevant to your practice, that describe the services you provide

•    Print out the detail of the measure or measures group that you have circled

Pay attention to:

•    Specific CPT® codes or code ranges

•    Specific diagnosis codes or any diagnosis codes

•    Measures that are applicable to many providers

•    Age limits, upper and lower

•    Gender limits

•    Whether your report at each encounter (antibiotic use for each surgery) or once during the reporting period (risk of falls)

•    How each can be reported: claims based, measures groups, registry

Worksheets and data collection sheets available:

http://www.ama-assn.org/ama/pub/category/20358.html

Claims based reporting—individual measures

Select three measures

• Review: what CPT® codes
• What diagnosis codes
• Age/gender
• Note: report per occurrence or per reporting period

How do you collect and report?

•    The clinical measure on which you are reporting must be documented in the medical record

•    Typically, the clinician (eligible professional in Medicare speak) would document it, but it could also be a lab report

•    Clinician must communicate that to biller/coder, which can be done on an encounter form, or by using the worksheets

•    Charge entry enters the quality data codes into the system when posting the charge

•    Verify that it is relevant: that is, does that quality data code match the CPT/ICD-9/AGE/Gender of the patient.  Currently, our practice management systems don’t allow us to verify this.  Can we build a program?  Integrate a commercial program into our systems?

•    Claim is submitted

Claims based reporting—measures groups. 

•    One measures group for 30 consecutive Medicare B FFS patients for each eligible professional from Jan 1-Dec 31 2009

•    One measures group for 80% of applicable Medicare B FFS patients of each eligible professional, minimum of 30 patients during period from Jan 1-Dec 31, 2009

Claims based reporting on measures groups using the consecutive patient option

•   When reporting measures group, you must report on all of the measures within the group

•    Print out the measure descriptions and the worksheets for all measures within the group

•    Worksheets are on the AMA web site, measures group descriptions and measures from CMS worksheet (refer to previous citations)

•   Report on only Medicare fee for service patients

•    Options: 80% of claims all year –why would you do this, OR on 30 consecutive patients any time during year

•    If one of these measures groups works for your practice, using the 30 consecutive patients option allows you time to plan to do it

•    Per provider/NPI—you could do it at different times for each provider

•    Select a day to start and submit one of these G codes on the first:

•    Report all measures on each patient who meets the criteria for age/diagnosis/CPT® code per the measure

•    Hold claims and review

•    Make sure for that provider no claims were submitted which meet the criteria that did not have the quality data codes submitted with them

•    BACK PAIN MEASURES BY MEASURES GROUP ONLY!  NOT INDIVIDUAL