2009 PQRI, E-Prescribing Tips

New guidance is available for electronic prescribing, or e-prescribing, and the Physician Quality Reporting Initiative (PQRI). A July 2 transmittal issued by the Centers for Medicare & Medicaid Services (CMS) will help ensure your practice qualifies for the full 2 percent incentive payment (for each program).

To implement 2009 PQRI and e-prescribing claims-based reporting of measures or measures groups, you must be an “eligible professional” (EP), use your National Provider Identifier (NPI), and submit billable services on Part B claims for allowable Physician Fee Schedule (PFS) charges. Claims processed by the Carrier or Medicare Administrative Contractor (MAC) must reach the national Medicare claims system data warehouse (National Claims History file) by Feb. 28, 2010 to be included in the analysis.

PQRI Basics

The specifications for a measures group are different from those for individual measures. Be sure to use the correct specifications.

EPs who choose to report individual PQRI quality measures should review the following documents:

  • “2009 PQRI Measure Specifications Manual for Claims and Registry,” and
  • “2009 PQRI Implementation Guide.”

Both documents can be found on the Measures/Codes section of the CMS PQRI Web site.

EPs who choose to report PQRI measures groups should review the following documents: 

  • “2009 PQRI Measures Groups Specifications Manual,”
  • “Getting Started with 2009 PQRI Reporting of Measures Groups,” and
  • “2009 PQRI Tip Sheet: PQRI Made Simple – Reporting the Preventive Care Measures Group.”

You can find the first two documents on the Measures/Codes section of the CMS PQRI Web site. The third document can be found on the Educational Resources section of the CMS PQRI Web site.

E-prescribing Basics

To be considered a successful e-prescriber for 2009 an EP must report an e-prescribing measure in at least 50 percent of reportable cases. For 2009, the e-prescribing measure may be reported via claims only.

EPs who choose to participate in the E-Prescribing Incentive Program should review the following documents, available on the E-Prescribing Measure section page of the E-Prescribing Incentive Web site:

  • “E-Prescribing Measure Specifications” 
  • “Claims-based Reporting Principles for E-Prescribing”
  • “Sample E-Prescribing Claim”

Educational resources to assist EPs in successfully participating in the E-Prescribing Incentive Program are also available on the Educational Resources section page of the E-Prescribing Incentive Web site.

Read CMS transmittal 513, change request 6514 for a high-level review on the coding and reporting principles for claims-based reporting of quality measures data for the 2009 PQRI and the e-prescribing measure for the 2009 E-Prescribing Incentive Program.

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One Response to “2009 PQRI, E-Prescribing Tips”

  1. Charlotte Davidson says:

    Do we submit the e-prescribing code for Medicare Advantage plans also?

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