Understand PQRI - simple steps to follow

Physician Quality Reporting Initiative Measures

PQRI is a measure enhanced by CMS to track preventive care done by the physicians.

Purpose of PQRI measures:
a)    To check on physician’s service quality
b)    To have a survey on how far these quality measures reaches people and
c)    To know how these measures are documented by CMS from the physicians

2% bonus on professional services would be provided to the Physician by the year end until 2011.
From the year 2012, reduction of 2% would be done on the professional services of the provider if these measures are not filed as they are mandatory.

Eligible Providers:
All providers who are enrolled under MCR are eligible to file these measures

Filing norms:
1. Minimum of 30 patients should be filed with PQRI services out of which at least 2 patients should be under Medicare within a year.

2. Registration depends upon the providers’ interest, i.e, PQRI measures could be filed either through Claims or through Registry.

    CLAIMS – There are two categories of measures by which provider could file these measures and they are INDIVIDUAL measures and GROUP measures (Common listed questionnaire would be considered as Group measures)
    a) Category II codes are to be filed for PQRI measures which would end with F and G codes.  G codes would represent Group measures.
    b) If provider opts for Group Measures then the first patient should be filed with appropriate G code and corresponding F ending codes could be filed based on the requirement.  If provider opts for Individual Measures then any applicable code ending with F, which is related to the service filed, could be billed.

    There are listed codes which are approved by CMS for both Group and Individual measures to be filed and it would keep changing every year.  Effective codes for the year 2010 are placed in the following path:

         c) Exclusion Modifiers – 1P, 2P, 3P and 8P
        These modifiers could be used for the following reasons:
i)    Measures not done due to Medical reasons – 1P
ii)    Measures not done due to lack of patient’s cooperation – 2P
iii)    Measures not done due to system reasons – 3P
iv)    Measures not done and reasons unspecified – 8P
    (8P is not advisable)
d) All codes which are filed to measure PQRI are termed are Numerator Codes
e)    And all the respective professional services are termed as Denominator Codes
f)    Provider should file only the applicable codes of Denominator along with Numerator codes

REGISTRY – There are certain listed Registries approved by CMS who would file PQRI measures on behalf of the providers.  Commission differs with each of the Registry.  Its up to the providers decision to select nominal Registry to file their PQRI measures.  This Registry would submit concerned Provider’s PQRI measures towards CMS and a commission would be collected from the provider per their contract.

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