Physician Quality Reporting Initiative (PQRI) Information

Background

The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI).

In 2008, The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).

As required by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-173), CMS has established 2 alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. The 2 alternative reporting periods are: January 1, 2009 - December 31, 2009 and July 1, 2009 - December 31, 2009. In total, there are 9 options for satisfactorily reporting quality measures data for the 2009 PQRI that differ based on the reporting period an EP chooses to report on, whether an EP chooses to report through claims or an approved clinical registry, and whether an EP chooses to report on individual measures or measures groups.

2009 PQRI

Detailed information about the 2009 PQRI, including the criteria for satisfactory reporting can be found in section O1 of the 2009 PFS final rule with comment period (73 FR 69817 through 69847), which was published in the Federal Register on November 19, 2008. To view the entire 2009 PFS final rule with comment period, click on the relevant link in the "Related Links Outside CMS" section below.

EPs do not need to sign-up or pre-register in order to participate in the 2009 PQRI. Submission of quality data codes for the 2009 PQRI quality measures to CMS through claims or a qualified registry will indicate your intent to participate in the 2009 PQRI.

2008 PQRI

The MMSEA authorized CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008. EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2008 - December 31, 2008, will earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2008 calendar year).

MMSEA authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. The document that establishes the new alternative reporting criteria and periods is the "2008 PQRI Establishment of Alternative Reporting Periods and Reporting Criteria".

2007 PQRI

PQRI was implemented on July 1, 2007 using Medicare's existing claims processing system as the mechanism for EPs to report quality data to CMS. The 2007 reporting period was July 1, 2007 to December 31, 2007. A total of 74 measures were available for the 2007 program.

A 2007 PQRI confidential Feedback Report is available by Tax Identification Number (TIN). If an EP correctly reported at least one quality data code for the 2007 reporting period a Feedback Report is available via the PQRI Portal on the Quality Net website.

Source: Centers for Medicare & Medicaid Services



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