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Physician Quality Reporting Initiative (PQRI) Click on the "Spotlight" link to the left to view "What's New" (recently posted items) for PQRI 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 professional 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). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-275) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). For each program year, CMS implements PQRI through an annual rulemaking process published in the Federal Register. Information regarding the relevant statutes and regulations can be viewed by clicking on the "Statutes/Regulations/Program Instructions" link at left. A "List of Eligible Professionals" who may participate in PQRI is available in the "Downloads" section below. No Sign Up or Pre-Registration Individual EPs do not need to sign-up or pre-register in order to participate in the PQRI. However, to qualify for a PQRI incentive payment an EP must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period. Note: The PQRI program requirements and measure specifications for the current program year may be different from the PQRI program requirements and measure specifications for a prior year. EPs are responsible for ensuring that they are using the PQRI documents for the correct program year. 2010 PQRI. To participate in the 2010 PQRI, individual EPs may choose to report information on individual PQRI quality measures or measures groups: (1) to CMS on their Medicare Part B claims, (2) to a qualified PQRI registry, or (3) to CMS via a qualified electronic health record (EHR) product. Individual EPs who meet the criteria for satisfactory submission of PQRI quality measures data via one of the reporting mechanisms above for services furnished during a 2010 PQRI reporting period will qualify to earn a PQRI incentive payment equal to 2.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period. Beginning with the 2010 PQRI, a group practice may also potentially qualify to earn PQRI incentive payment equal to 2% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2010 PQRI reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS. Click on the "Group Practice Reporting Option" link at left to learn more about this reporting option and to obtain instructions on how a group practice can sign up to participate in this reporting option. 2009 PQRI. To participate in the 2009 PQRI, individual EPs may choose to report information on individual PQRI quality measures or measures groups: (1) to CMS on their Medicare Part B claims or (2) to a qualified PQRI registry. Individual EPs who meet the criteria for satisfactory submission of PQRI quality measures data via one of the reporting mechanisms above for services furnished during the a 2009 PQRI reporting period will qualify to earn a PQRI an incentive payment equal to 2.0% of their total estimated Medicare Part B PFS allowed charges for covered professional services furnished during that same reporting period. Additional information on the registry-based or, beginning with the 2010 PQRI, EHR-based reporting mechanism for the PQRI is available by clicking on the "Alternative Reporting Mechanisms" link at left. Information on the PQRI Individual Quality Measures or Measures Groups can be found by clicking on the "Measures Codes" link at left. Information on PQRI incentive payments, feedback reports, and validation of satisfactory reporting can be found by clicking on the "Analysis and Payment" link at left. Click on the "Educational Resources" link at left to access educational materials and resources on how to satisfactorily participate in PQRI. Updated tools are available to assist professionals in PQRI reporting. To access these tools, click on the "PQRI Tool Kit" link at left. To find out who to contact with questions regarding the PQRI, click on the "Help Desk Support" link at left. NOTE: All PQRI information specific to a PQRI program year prior to 2009 has been archived. Please click on the appropriate PQRI Program link at left to view information specific to a previous year's PQRI. 2007 PQRI Reporting Experience. A report on the 2007 PQRI reporting experience outlines the issues identified for 2007 and CMS plans for modifications to the analytics for the 2008 PQRI. This report is available in the "Downloads" section of the "2007 PQRI Program" link at left. Letter to Medicare Beneficiaries. CMS has posted a letter to Medicare beneficiaries with important information about the PQRI. The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy to their patients in support of their PQRI participation. To obtain a copy of the letter, see the "Related Links Inside CMS" section below.
Page Last Modified: 11/18/2009 11:06:04 AM
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