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Physician Quality Reporting Initiative (PQRI) Changes
Steve Rhinehart
Coding Operations Manager
CMS is transforming Medicare from a passive payer to an active purchaser of value-based services. One step is to measure the quality of services purchased by having outpatient providers (Medicare Part B) report specific quality measures that are considered standards of care. These measures are similar to inpatient measures that have been in place for some time and are a component of the Physician Quality Reporting Initiative (PQRI).
After receiving feedback from providers on the proposed measures, four related to stroke patients were recently removed from ED reporting. This leaves 9 measures for ED reporting out of the 74 outpatient quality measures Medicare is tracking this year.
This reporting program is currently voluntary, but does offer a financial incentive to participating physicians. PQRI reporting can earn physicians up to 1.5% of their Medicare allowable charges for the period of July through December if an adequate number of measures are reported on Medicare bills, and other criteria are met.
Additional information is available on CMS Web page located at: http://www.cms.hhs.gov/PQRI/. The tabs on the left side of the Web page offer links to program details, such as the specific measures collected, how the bonus is calculated and more.
It is expected Medicare will increase the number of quality measures and financial incentives in 2008 and beyond as it moves toward a pay for performance model. LYNX recommends that eligible providers begin reporting these measures during this six month period. Our coding clients currently have the option of LYNX assigning PQRI codes for reporting to CMS.
If you have not discussed this option and/or the specifics related to documentation, chargemaster and reporting, please call 800-767-5969 or email your LYNX coding manager or account executive for more information.