PQRI — Are You Cashing In?
Physician Quality Reporting Initiative (PQRI) is an incentive offered by Medicare to Medicare providers. PQRI will focus attention on quality of care. This program is paving the way for Pay for Performance.
Providers will use Category II codes, modifiers and temporary G-codes to report 74 unique measures associated with clinical conditions that are routinely represented on Medicare Fee for Service claims. The measures address various aspects of quality of care associated with prevention, chronic care management, acute episode of care management, procedural related care, resource utilization, and care coordination.
Some measures have a Performance Timeframe (i.e., perform within 12 months) that may be distinct from the Reporting Frequency (i.e., report 1 time only). If four or more measures are applicable for the practice, the provider must report at least 3 of them correctly for at least 80% of the cases (visits or patients). If 3 measures or less are applicable, the provider must report all of them correctly for at least 80% of the cases.
PQRI begins with services performed on July 1, 2007 thru December 31, 2007. Providers that report successfully are eligible for a 1.5% bonus subject to a cap. The bonus is calculated using total allowed charges for Medicare covered professional services furnished during the reporting period. All claims for services performed during these dates must be submitted to Medicare by February 29, 2008 to be considered. The bonus payment will be made next summer.
Providers wishing to participate in the PQRI need not register. All you do is begin reporting for services performed beginning July 1st. You must be a Medicare provider and use your individual NPI on your claims to be eligible to participate.
To find out more, visit the PQRI website.
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