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July 2007

PQRI Creates “Buzz” and Bonuses

There’s nothing quite like another quality incentive to get health care providers talking. Nothing, that is, except the possibility of bonuses paid to providers who participate. And that’s exactly what’s happening with the Physician Quality Reporting Initiative (PQRI).

Few other regulatory initiatives in recent memory have created the stir that PQRI has. Fortunately, though, few others have been accompanied by the wealth of supportive and educational resources that accompany this one.

The PQRI is a first step toward linking Medicare health professionals’ payments to quality, which is consistent with Medicare’s ongoing transformation from passive payer to active purchaser of high-value health care. Physicians and other eligible professionals who choose to participate in 2007 may earn a bonus payment of 1.5 percent of total allowed charges for covered services, and they will gain experience in capturing and submitting data on the quality of care they submit through the claims process.

The Centers for Medicare and Medicaid Services (CMS) PQRI web site and related CMS communications channels are the authoritative sources for accurate, up-to-date information on the 2007 PQRI. Briggs also offers supplementary information and tools necessary for an office to collect and report the quality measures to CMS.

The Physician Guide to Implementing the Medicare Quality Reporting Initiative available from Briggs as stock no. 8592 includes an in-depth analysis of the new rule. It features the following:

• A PDF of the book on CD, which is fully searchable. Click on a hyperlink and go instantly to the page or section you need for searches that are easy, fast and convenient. 

• Details that are not found in the CMS handbook. Each of the 74 PQRI measures has its own chapter providing: a description of the Quality Measure (QM), directions on how to code the QM and other important information.

The Physician Guide to Implementing the Medicare Quality Reporting Initiative  also provides: guidance on developing PQRI Implementation Procedures for your practice and information on what to expect in 2008. There are worksheets for each of the 74 Quality Measures that will help you determine when a quality indicator code should be submitted as well as quality measures by category.

For the record, PQRI was created on December 20, 2006 when the President signed the Tax Relief and Health Care Act of 2006 (TRHCA).

To participate in the 2007 PQRI, physicians and other eligible professionals as defined by the Tax Relief and Health Care Act of 2006 (TRHCA) should begin by reviewing the detailed 2007 PQRI Quality Measure Specifications. Related informational materials are available on the CMS PQRI web site as well as select measures applicable to patient panels and services the professional furnishes his or her patients.

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007 may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee
schedule services.

The eligible professionals should then report the selected measures by submitting the specified quality-data codes on claims for services paid under the Medicare Physician Fee Schedule and provided between July 1 and
December 31, 2007.

A PQRI participant who reports successfully will be eligible for a lump-sum bonus payment for services provided during the reporting period as established by the Tax Relief and Health Care Act of 2006 (TRHCA).

The reporting period for 2007 PQRI begins on July 1, 2007 for covered services provided to Medicare beneficiaries between July 1 and December 31, 2007 and paid under the Medicare Physician Fee Schedule.

Jim Baker
Director of Marketing, Briggs Corporation

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