Reporting on Medicare Measures

Medicare’s new pay for reporting program

Clinical members of NASW Washington should be aware of Medicare’s new pay for reporting program, the Physician Quality Reporting Initiative (PQRI) that applies to many providers—not just doctors.

PQRI might not be relevant to all your members; it is worth knowing about, especially for those who work with the Medicare population.  There is one measure on depression that maybe applicable. PQRI is currently optional though there is certainly potential for it to be required in the future. Here’s a little background:

The Tax Relief and Health Care Act of 2006 authorized the Physician Quality Reporting Program (PQRI), which is a pay for reporting program for all providers who bill under Medicare Part B, and no enrollment or registration is required. The initial period is July 1 through December 31, 2007 during which a set of 74 quality measures, that have been adopted or endorsed by a consensus organization, will be used. Each measure has temporary G-codes and/or CPT category-2 codes that should be added to claims to reflect elements of quality of care delivered. Measure specifications are expected to be available in early April. A lump sum payment of 1.5% of total allowable charges for covered services provided during the period, subject to a cap, will be made to those that successfully report at least 80% of the cases in which the measure is reportable for at least three measures, or for the number of measures applicable to their practice if numbering one or two. Additional information is available on the PQRI website .

Additional Information

Instructionsfor subscribing to a LISTSERV

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 2007 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.
You can stay informed of the latest program developments by visiting the PQRI webpage and by subscribing to the Physician Quality Reporting Initiative LISTSERV.

To subscribe to the LISTSERV, send an e-mail to listserv@list.nih.gov with the following text in the message body:

Subscribe CMS_PQRI [your first and last names]

e.g., subscribe CMS_PQRI Kenny Fink

Please feel free to contact Ashley Katz, MSW, Centers for Medicare and Medicaid Services Region X, 206-615-2540, with any questions.

back to Currents »