PQRI Physician Quality Reporting Initiative: an Overview

March 5th, 2009 - Betsy Nicoletti
Categories:   Coding   MIPS|PQRS|PQRI  
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PQRI The briefest of historical reviews

2007: 1.5% potential payment with cap on total payment

•    Half year reporting period

•    Bonus payment subject to cap

•    1.5% of total allowed Medicare Fee Schedule payments

•    Includes Railroad Retirement Board charges

•    Excluded are labs (not paid under MFS) and any claims submitted to Part A Fiscal Intermediary, such as Rural Health Claims, FQHCs

•    Excluded  are drugs, drug administration charges are included

•    Excluded HPSA bonuses

•    Claims based

•    74 measures

•    Low participation rate, lower success rate, difficulty in accessing reports

2008: 2% potential payment

•    Full and half year reporting allowed, bonus based on charges during reporting period

•    Eliminated cap on incentive payment

•    Allowed for alternative reporting options, including registry and measures group reporting

•    Allowed for claims based and consecutive patient reporting

•    Total of 9 PQRI Reporting methods, 3 claims based, 6 registry based

PQRI for 2009

•    Still voluntary for 2009

•    2% potential bonus of allowed Physician Fee Schedule charges (same definition of allowed charges as 2007, 2008)

•    No need to register to participate

•    Report options: claims based, Registry, Measures groups

•    Report using “Quality Data Code” QDC.  These are either  HCPCS codes or CPT® II codes.  Some measures have modifiers as well

•    Must report on at least 3 measures for 80% of the applicable cases

•    If only one or two measure applicable, then report on these 80% of time

•    If only one or two measures, look again at the measures that apply to many providers, any specialty


Which is  an example of successful reporting?

Reporting 80.5% of the time on 3 measures?


Reporting 79.9% of the time on 10 measures?

The first!  So, concentrate on 3 measures.




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