Abbreviated PQRI and E-Prescribing Guidance

Have you had a chance to read the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) yet? How about the 2009 Medicare Physician Fee Schedule (MPFS) final rule? Come on, it’s only 513 pages! Well, if you’re short on time, you may want to read Transmittal 459, Change Request (CR) 6394. The Centers for Medicare & Medicaid Services (CMS) issued the transmittal March 20 to provide an overview of the 2009 Physician Quality Reporting Initiative (PQRI) and E-prescribing Incentive Program.

Section 132 of MIPPA includes many provisions that impact 2009 PQRI and also authorizes a new and separate E-Prescribing Incentive Program.

Transmittal 459 summarizes changes to the 2009 PQRI with regards to: 1) eligibility; 2) reporting methods; 3) reporting periods; 4) payment for reporting; 5) individual quality measures; 6) measures groups; 7) determination of satisfactory reporting; 8) validation; 9) appeals; and 10) confidential feedback reports.

Also in the transmittal is an overview of the 2009 E-Prescribing Incentive Program that addresses the following: 1) eligibility; 2) reporting methods; 3) reporting periods; 4) payment for reporting; 5) determination of a successful e-prescriber; and (6) confidential feedback reports.

You’ll find all sorts of valuable information quickly and easily in the transmittal. For example, did you know that speech-language therapists are unable to participate in the PQRI and E-Prescribing Incentive Program because they do not bill Medicare directly? Come July 1, however, this may change.

Here’s another juicy tidbit: The PQRI incentive payment applies to allowed charges for all covered professional services under the MPFS, not just charges associated with reported quality measures. The term “allowed charges” refers to total charges, including the beneficiary deductible and copayment, not just the 80 percent paid by Medicare or the portion covered by Medicare where Medicare is the secondary payer.

To catch up on your reading, follow the above link to the CMS Web site.


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2 Responses to “Abbreviated PQRI and E-Prescribing Guidance”


    I would welcome a seminar/conference just for PQRI education. As we are a pain mgmt group and also have a rehab dept, I would only be interested in PQRI that can be used for these specialties.

  2. Sandy says:

    I, too, would welcome a seminar covering all aspects of the PQRI pertaining to physical therapy.

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