Physician Quality Reporting Initiative (PQRI) is NOW supported!!! Start now to send the quality reporting "charges" so that you are able to reach the goal of 80% for the final two quarters of 2007.

The quality reporting zero ($.00) "charges" can be easily entered in PIMS--just enter them as charges along with the CPT4 codes.  PiMS is allowing the CPT II codes to be entered into the charge master so that the CPT II code can be sent electronically or printed on an 1500 claim form.  If you are unfamiliar with the PQRI, please read the following and check out the links.

PQRI Information and Links

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).

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% of total allowed charges for covered Medicare physician fee schedule services.

Reporting Requirements

Reporting on just three measures 80 percent of the time for fee-for-service Medicare patients who are eligible for those measures can lead to an incentive bonus equal to 1.5 percent of all your Medicare billings for the six-month reporting period, which begins July 1, 2007.

Preliminary calculations show that a family physician could receive a bonus in July 2008 that ranges from $400 to $1,400, approximately, depending on what percentage of your revenue comes from Medicare (typically between 10 percent and 35 percent). The best way to calculate your potential bonus is to divide your total Medicare practice revenue for 2006 in half (to account for the six-month reporting period) and then multiply by 1.5 percent.

This may not seem like a lot of money, but there is another inducement to participating in this voluntary pay-for-reporting initiative. More and more commercial carriers are moving toward programs that will require you to report clinical performance measures. By collecting and reporting data now, you will be prepared to respond to market-specific incentives as commercial insurers introduce them.

The 74 measures include aspects of treatment and screening for Medicare patients with diabetes, heart disease, depression, stroke, glaucoma, cataracts, osteoporosis, melanoma, end stage renal disease, asthma and pneumonia.

Links for More Information