The Pay for Performance Program takes off



The Pay for Performance Program takes off

Medicare is going to pay offices a bonus for participating in a new voluntary program that begins July 1, 2007.

The program is an extension of last year’s quality reporting system where doctors coded quality measures in a limited number of areas.

The new system is called 2007 Physician Quality Reporting Initiative or PQRI, and it is very much the beginning of something coming soon to full bloom.

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

For all related FAQ’s about this program, please go to the following link:



Reporting

|Eligible professionals need not enroll or file an intent to participate for the PQRI. Eligible professionals can participate by |

|reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor. |

|In order to satisfactorily meet the requirements of the program and receive the bonus payment, certain reporting thresholds must |

|be met. When no more than three quality measures are applicable to services provided by an eligible professional, each such |

|measure must be reported in at least 80% of the cases in which the measure is reportable. When four or more measures are |

|applicable to the services provided by an eligible professional, the 80% threshold must be met on at least three of the measures |

|reported. |

|Eligible professionals need not register or file an intent to participate for the PQRI. While reporting for the 2007 PQRI begins |

|with claims for dates of service as of July 1, 2007, eligible professionals should become familiar with the 2007 PQRI measures |

|before the reporting period begins. |

Eligible Professionals

|Under PQRI, covered professional services are those paid based on the Medicare Physician Fee Schedule. To the extent eligible |

|professionals are providing services which get paid under the Medicare Physician Fee Schedule, those services are eligible for |

|PQRI. |

|TRHCA section 101 defines "eligible professional" as the following: |

|Medicare physician, as defined in Social Security Act (SSA) section 1861(r) |

|Doctor of Medicine |

|Doctor of Osteopathy |

|Doctor of Podiatric Medicine |

|Doctor of Optometry |

|Doctor of Oral Surgery |

|Doctor of Dental Medicine |

|Chiropractor |

|Practitioners described in SSA section 1842(b)(18)(C) |

|Physician Assistant |

|Nurse Practitioner |

|Clinical Nurse Specialist |

|Certified Registered Nurse Anesthetist |

|Certified Nurse Midwife |

|Clinical Social Worker |

|Clinical Psychologist |

|Registered Dietician |

|Nutrition Professional |

|Therapists |

|Physical Therapist |

|Occupational Therapist |

|Qualified Speech-Language Therapist |

Is the program Mandatory?

• The program is 100 % voluntary; physician’s who do not participate will not be penalized.

How to Participate

• Doctors do not have to enroll in the program or register anywhere. All that is necessary is to use the quality codes after July 1,2007. The codes go on the same claims form as the diagnosis and procedure codes.

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