Attention: Physicians Who Are Participating in the 2007 Physician Quality Reporting Initiative (PQRI)

The July 1, 2007 effective date has prompted the Centers for Medicare & Medicaid Services (CMS) to develop and release a Tool Kit for the 2007 Physician Quality Reporting Initiative (PQRI) that will assist eligible professionals with successful reporting. This Tool Kit consists of some existing educational resources plus new measure-specific worksheets designed to walk the user step-by-step through reporting for each measure.  

The Tool Kit is now a featured section on the CMS PQRI web page. To access the Tool Kit, visit:

http://www.cms.hhs.gov/PQRI

Scroll down to the PQRI Tool Kit tab. The page serves as a "Read This First" Guide to the resources that are available to download.

The Tool Kit consists of the following and will assist eligible physicians in the successful integration of PQRI measurement into their practice.

It is strongly suggested that eligible physicians review and discuss the following materials with their staff and take the following steps.

1. 2007 PQRI Physician Quality Measures – A numerical listing of all measures included in 2007 PQRI.

• Review the list of 74 measures and determine which measures apply most frequently to the practice's Medicare Fee-for-Service (FFS) patients.
• Select the measures that the practice will report on Medicare claim forms.

2. MLN Matters Article 5640 - Coding & Reporting Principles – A publication that introduces the coding and reporting principles underlying successful PQRI reporting.

• Review, discuss, and disseminate this publication to staff.

3. 2007 PQRI Code Master – A numerical listing of all codes included in PQRI intended for incorporation into billing software.

• Ensure that the practice's billing software can capture all the codes and associated modifiers used in PQRI that are included in the Code Master.

4. 2007 Coding for Quality Handbook – A Handbook that delineates coding and reporting principles and provides implementation guidelines for how to successfully report measures using clinical scenarios.

• Read and discuss the principles, clinical scenarios, and implementation guidelines for each of the measures selected for reporting in PQRI.
• Develop a process for concurrent data collection so that PQRI codes are correctly identified and entered onto Medicare FFS claims.
• Review the sample workflow diagram included in the Handbook to plan any changes to workflow so that all PQRI quality data codes may be captured on claims for Medicare services.

5. 2007 Data Collection Worksheets – Measure-specific worksheets that walk the user step-by-step through reporting for each measure. These worksheets may be used by the practice on a concurrent basis to collect PQRI data upon patient arrival for appointments.

• Identify the patients for whom PQRI measures and codes apply.
• Capture clinical information for translation into the administrative claim process.
• Integrate the measures into your practice.
• Maintain a copy of the Worksheet to enable QI and tracking at the practice level.

This is a complex subject and physicians are urged to take advantage of any and all resources to properly understand how this new program will work. Many questions have been received with regard to how many of the quality measures must be used to reach the 80% threshold.

First, physicians must consult the CMS-approved list of 74 quality measures to decide how many to report and determine how many of their Medicare patients fit into those categories. To be eligible for the bonus, doctors must report on at least three measures and apply each one to at least 80% of the patients who fit that category.

Physicians who see a significant number of diabetic patients, for example, might decide to keep special tabs on whether these patients maintain their blood pressure control -- one of the CMS quality measures.

To meet this requirement, a doctor would have to share with the government (or report via the quality measures codes) the individual blood pressure ranges of at least 8 out of 10 under-control diabetic patients during one or more of their follow-up office visits in the last half of the year.

If there are questions on how best to report these measures, contact us through the Third Party Payer Coding Help Program.