The 2006 Tax Relief and Health Care Act (TRHCA) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
No Sign Up or Pre-Registration
Individual EPs do not need to sign-up or pre-register in order to participate in the PQRI. However, to qualify for a PQRI incentive payment an EP must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period.
Note: The PQRI program requirements and measure specifications for the current program year may be different from the PQRI program requirements and measure specifications for a prior year. EPs are responsible for ensuring that they are using the PQRI documents for the correct program year.
2010 PQRI. To participate in the 2010 PQRI, individual EPs may choose to report information on individual PQRI quality measures or measures groups:
- to CMS on their Medicare Part B claims
- to a qualified PQRI registry
- to CMS via a qualified electronic health record (EHR) product.
Individual EPs who meet the criteria for satisfactory submission of PQRI quality measures data via one of the reporting mechanisms above for services furnished during a 2010 PQRI reporting period will qualify to earn a PQRI incentive payment equal to 2.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.
Beginning with the 2010 PQRI, a group practice may also potentially qualify to earn PQRI incentive payment equal to 2% of the group practice’s total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2010 PQRI reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS.
2009 PQRI. To participate in the 2009 PQRI, individual EPs may choose to report information on individual PQRI quality measures or measures groups: (1) to CMS on their Medicare Part B claims or (2) to a qualified PQRI registry. Individual EPs who meet the criteria for satisfactory submission of PQRI quality measures data via one of the reporting mechanisms above for services furnished during the a 2009 PQRI reporting period will qualify to earn a PQRI an incentive payment equal to 2.0% of their total estimated Medicare Part B PFS allowed charges for covered professional services furnished during that same reporting period.