2007 Physician Quality Reporting Initiative (PQRI)
Lynne Kottman, CCP, CHMBE
Legislative Advocate
PQRI = New program PVRP = Old program (which is going away) Summary from conference call with Sue Nezda, MD, FACEP from CMS Unchanged from past information: CMS will pay 1.5% of all Medicare charges including co-pays, not just the charges for items being measured – (she specified that they consider charges to be the Medicare payable amounts.) Providers will need to report on at least 80% of at least 3 quality measures
Updated information: At this time, CMS has no plans to register providers, they will be registered by virtue of submitting the appropriate codes Providers can begin at any time from now to July 1 reporting the codes, but they will not be paid for that time frame, and CMS will not provide any feedback or reporting for that time frame. These quality measures will be linked to specific Diagnosis and they will be establishing the links between the measures and appropriate diagnosis. Payment will be made in a lump sum, based on the TIN under which these have been submitted. So if a provider has assigned their Medicare payments to an entity, that entity will receive the payment, in bulk. The lump sum payment will be made sometime mid-2008. The reporting will occur sometime mid-2008 The denominator used for determining the Cap on payments will not be established until all of the designated claims for 2007 have been reported The measures are close to being set and will resemble the 66 measures released for PVRP for January 1, 2007. CMS is expected to continue on with most of those measures (some may fall off, additions are less likely) but the specifications of the measures- the details in which the devils reside- may change. That process is a moving target with many of the measures still moving through NQF in the February-March time period. Payments will not include Medicare replacements, like Medicare Advantage The CMS site with the most current information is currently scheduled to be up on or about Feb 15.
Requests for CMS’s consideration: Requested that CMS, at the minimum, report that they are receiving these reported codes so that an entity wouldn’t find out until mid 2008, when they didn’t received payment, that the appropriate modifiers were not getting through That CMS consider at least a minimum reporting period prior to implementation in July 2007 for providers to test submissions of the quality measure modifiers or codes That CMS work with the clearing houses to make sure they are not filtering out zero charge claims during the submission process That CMS reports payments on at least a facility level within a TIN That CMS “vet” for appropriateness the diagnosis linkages with provider groups prior to putting them into place.
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