Why did so few physicians receive a PQRI bonus for 2007?

CMS released a report describing the common errors in claims submission, that resulted in physicians not receiving a bonus.  

Before we discuss these, keep in mind that there is no appeal in the PQRI program for practices that believe they successfully reported.  There are no interim reports.  It is a leap of faith to start the process and continue, with no feedback possible for over a year.  It is a leap of faith, but because CMS is committed to moving from a “passive payer” to an “active purchaser of quality services,” many practices are making the leap.

Common errors:

•    Reporting the wrong Quality Data Code for the measure.  Each measure has a set of 3-5 QDCs that may be reported only when the service meets the criteria described in the measure.  

•    Physicians reported the wrong diagnosis code for the measure.  If the  measure is one of the diabetes codes, for example, link the QDC to the diagnosis of diabetes.

•    The patient age did not match the measure.  Some codes do not have an age specified, some are over 18, or 18-75.  Physician practices reported on patients who did not meet the criteria by age.  Although that doesn’t count against a practice, it also doesn’t count towards the 80% needed for a successful reporting.

•    Physicians reported on some measures once in a reporting period, per patient, when the measure required reporting for each incident of care.  Read each measure carefully to determine if the practice should report once during the reporting period or at each incident of care.

•    A patient was seen in coverage by the physician’s partner, and the physician’s partner did not report, because the physician had already done so.  But, this lowers the reporting percentage of the covering physician, if the patient meets the requirements for one of the measures for which the covering physician is reporting