Eligible physicians not yet participating in the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting Initiative (PQRI) have an incentive to start before the program becomes mandatory. Participating physicians can earn an incentive payment of 2 percent of their total allowed charges for professional services paid under the Medicare physician fee schedule in 2009.
Currently, PQRI is a voluntary program in which physicians collect and report practice data from a set of performance measures. PQRI will eventually transition to a mandatory pay-for-performance program. IDSA encourages its members to take advantage of the current voluntary nature of PQRI to gain experience with reporting quality metrics.
Although PQRI is still voluntary, CMS will begin publicly reporting the names of providers who successfully participate in the 2009 PQRI at www.medicare.gov/physician. Once pay-for-performance is mandatory, CMS may also publicly report physicians’ quality and efficiency data online.
Some participating physicians have reported that they did not receive incentive payments in 2007 and are reluctant to participate in 2009. According to CMS, easily avoidable reporting errors were among the reasons that physicians did not receive incentive payments for quality reporting last year. These errors included reporting the incorrect diagnosis code or codes, reporting the incorrect age or sex of the patient, or failing to include appropriate provider identifiers on the claim.
In some cases, billing software split a claim into smaller claims. When this has happened, one claim may have included the quality data codes while the other claims contained the CPT service and diagnosis codes. In some cases Medicare could match split claims together by National Provider Identifier, date of service, and other data—but often could not.
Several new measures have been added to PQRI for 2009 that may better enable ID physicians to participate. New quality measures include those relating to HIV/AIDS and wound care. The IDSA website has much more information about PQRI and other quality improvement efforts, including a summary of measures that might be relevant to your practice, reporting options and instructions, and information about electronic-prescription incentive payments.
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