Physicians Quality Reporting Initiative (PQRI)
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What is PQRI?

On December 20, 2006 President Bush signed the Tax Relief and Health Care Act of 2006 authorizing the establishment of a physician quality reporting system by the Centers for Medicare & Medicaid Services (CMS). CMS titled the statutory program the Physician Quality Reporting Initiative (PQRI). The initiative evolved from the Centers for Medicare & Medicaid Services (CMS) program titled, Physician’s Voluntary Reporting Program (PVRP), which was started in 2006.

PQRI establishes a financial incentive for physicians to participate in a voluntary quality reporting program. Those doctors 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.

What is the difference between PQRI and PVRP?

PQRI has added additional measures to track and some measures have been updated/altered. It is also estimated that the average bonus paid out to the reporting physician could be $10-15K for an average practice. There was no incentive bonus for PVRP.

How does PQRI work?

The quality measures under PQRI use a combination of E&M visit codes, diagnosis codes, procedure codes, possible age or other restrictions, and either CPT II or G codes. The diagnoses codes, procedure codes, E&M codes, and other restrictions combine to determine eligibility of a patient for a measure. This is also called the denominator. The CPT II or G code and possible modifiers reports the outcome, also known as the numerator.

Where can I learn more about PQRI?

If you want to participate in the program, it is imperative that you fully understand it and understand which measures apply to your practice, the specifics of the measures, as well as the reporting requirements required for those measures.

For more detailed information about the Physician’s Quality Reporting Initiative, you can access the CMS PQRI Overview page on the US Department of Health and Human Services website.

You can also find specification documents on the CMS PQRI Measures/Codes page.

How will MediNotes help me implement PQRI reporting?

There are several ways to implement PQRI reporting in your office, and how you do so is at your discretion. The document, titled MediNotes and PQRI:

• Briefly outlines PQRI
• Identifies the files you need to download and install to update your system
• Provides several strategies for implementing PQRI
• Makes additional recommendations and considerations

How do I get started?

• Download and save the MediNotes and PQRI document.
• Click the Downloads Page and proceed to download and save the 2 files needed to update your system: MediNotes e 2007 PQRI Code Update and MediNotes e PQRI Content Update.
• Follow the instructions to install the files and update your system. Please note that the instructions are located on the download page for each file and that it is imperative you install the files in a specific order!
• Once your system is updated, read through the MediNotes and PQRI document.
• As recommended in the MediNotes and PQRI document, download detailed PQRI specifications from the PQRI section of the CMS website and read them if you have not done so already.

So what’s next?

Once everything is installed and your practice has decided on a strategy for implementing PQRI, test your proposed workflows from beginning to end several times. Have every staff member participate, and answer questions as they arise. Don’t wait until the first day of reporting to find out you have holes in your PQRI strategy.

What if I have questions?

If you have any questions please contact your Practice Success Manager or email pst@medinotes.com.