AMCNO PQRI Teleconference Provides Information to Practices Statewide

This week, the AMCNO co-sponsored a teleconference with Palmetto GBA on the topic of the Physician Quality Reporting Initiative (PQRI) for 2008. The AMCNO organized this event in partnership with PalmettoGBA in an effort to clarify for our members and for physicians across the state PQRI’s 2008 components and requirements. Our featured speaker, Dr. Daniel Green, of the Center for Medicare and Medicaid Services (CMS), clearly outlined the incentive structure and reporting details. Dr. Green explained that medical practices would be eligible for a 1.5 percent bonus under the Tax Relief and Health Care Act of 2006, which authorized the creation of the PQRI. The PQRI was first launched the last half of 2007 and will continue in 2008. The PQRI program will continue to pay physician practices a bonus payment in 2009 for reporting validated quality measures during 2008. This is a voluntary program that will provide a financial incentive not only to physicians but many other eligible professionals who successfully report quality information related to services provided under the Medicare Physician Fee Schedule during the course of this year. 

There are now 119 reportable quality measures posted at www.cms.hhs.gov/PQRI . The PQRI 2008 program began on January 1, 2008, however, it is not too late for physicians to begin participation in the 2008 program. For those that wish to participate you may gather information and educational materials, along with detailed measure specifications and instructions on the PQRI web page noted above. In addition, the American Medical Association has posted additional information on the measures and how to comply with the PQRI program – to view the AMA site go to www.ama-assn.org.  Another helpful tool is the Coding for Quality – A Handbook for PQRI Participation – also contained on the PQRI website.

The same reporting requirement thresholds continue in 2008 -i.e. if there are no more than 3 measures that apply, each measure must be reported for at least 80% of the cases in which a measure is reportable; and if 4 or more measures apply, at least 3 measures must be reported for at least 80% of the cases in which the measure was reportable. To be included in the PQRI process, the claim must include an accurate use of the National Provider Identifier (NPI.) Participating eligible professionals who successfully report may earn a 1.5% bonus (there is NO CAP applied this year). The 1.5% bonus calculation is based on the total allowed charges for all Medicare patients seen in 2008 during the reporting period for professional services billed. Bonus payments will be made in a lump sum in mid-2009 and the bonus payments will be made to the holder of record of the Taxpayer Identification Number (TIN). Physicians will receive confidential feedback reports that will include reporting and performance rates by NPI or each TIN.

The form and manner of reporting will once again be claims-based using CPT Category II codes (or temporary G-codes where CPT Category II Codes are not yet available) for reporting quality data. The CPT II codes are included in the CPT codebook and these codes are also posted on the CMS web site. Some measures have a performance timeframe related to the clinical action that may be distinct from the reporting frequency. Each measure has a reporting frequency requirement for each eligible patient seen during the reporting period i.e. report one-time only, report once for each procedure performed, or report for each acute episode.

To ensure success physicians should start reporting early to increase the probability of achieving the 80 percent rate of reporting during the reporting period. Also be sure to report on as many measures as possible to increase the likelihood of achieving successful reporting.

Copies of the slides presented during the AMCNO/PalmettoGBA co-sponsored event are available on the AMCNO web site at www.amcnoma.org in the Practice Management link.