Part B Insider (Multispecialty) Coding Alert

Published on Fri Jan 16, 2009 PDF

Plus: CMS offers two reporting periods for PQRI participation.

Want to collect your maximum physician quality reporting initiative (PQRI) bonus this year? CMS just made things a little bit easier.

During a Jan. 13 CMS Open Door Forum, Medicare officials outlined the process that you'll have to follow if you want to collect your bonus this year. Following are a few highlights of the call:

More measures: While Medi-care offered 119 PQRI measures in 2008, you'll find 153 measures this year. Plus, CMS removed e-prescribing as one of the measures because it now comprises a separate incentive program, said CMS' Dan Green, MD, on the call.

Reporting periods: CMS will allow two reporting periods this year. The first period runs from Jan. 1 through Dec. 31, 2009. The second reporting period (also known as the 6-month reporting period) goes from July 1 through Dec. 31.

The full-year option (Jan. through Dec. 2009) "includes all options of reporting: individual measures by claims and registries, measures groups, and also registry reporting in general," Green said on the call. The six month reporting period (July through Dec. 2009) includes only measures groups and/or registry reporting.

Measures: If you participate in the full-year program, you can report on three individual measures 80 percent of the time in 2009, Green said. If three measures don't apply, you can report on one or two measures, "but they will be subject to validation if they report on fewer than three measures."

Keep in mind: In 2009, CMS has 7 measures groups -- the ESRD measures group was removed. Also, Green noted, back pain was added as a measures group and is only reportable as a measures group -- not individually.

The coronary artery bypass grafting measures group is only reportable through registries, Green noted.

In 2009, the incentive payment has been increased from 1.5 percent of all covered Part B charges to 2 percent and there is no payment cap, Green said during the call.

CMS created several PQRI resources on its Web site -- including a 2009 "PQRI Implementation Guide" and its "Getting Started With 2009 PQRI Reporting of Measures Groups." To access these resources, visit the CMS Web site at: www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp.