It is not too late to participate in the Centers for Medicare & Medicaid Services’ (CMS) 2009 Physician Quality Reporting Initiative (PRQI). Participation is voluntary, but providers who participate now will better prepare themselves for probable future reporting requirements while qualifying for an incentive payment from CMS. PQRI rules and details are available at www.rheumatology.org/practice/pqri. There are nine possible options to report data to CMS for PQRI, and six of these can be used by those starting PQRI mid-year.
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Explore This IssueJuly 2009
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Below are four simple steps to help you choose the best method for reporting this data. You can find more information in the CMS’ 2009 Physician Quality Reporting Initiative Implementation Guide, located at www.cms.hhs.gov/PQRI/Downloads/2009_PQRI_ ImplementationGuide_040909.pdf.
Step 1: Become familiar with the specific parameters of the measures that might apply to your practice. Although rheumatologists and other eligible rheumatology health professionals can choose to report on any of the 153 PQRI 2009 measures, many will choose the rheumatoid arthritis measure group. Other measures most applicable to rheumatology include screening and management of osteoporosis, assessment of pain, osteoarthritis, falls, back pain, and use of health information technology (such as an electronic health record). Measure specifics are available at www.rheumatology.org/practice/pqri/measures_index.asp.
Step 2: Select the measures and time period on which you would like to report. Select measures based on your patient mix. Then, consider if you will report for a six- or 12-month period. Even for those starting PQRI mid-year, there are options you can use to report for the entire calendar year and receive the full bonus payment of 2% of your 2009 Medicare Part B billings.
Step 3: Select a method to transmit the information to Medicare. Information can be transmitted to Medicare via claims or a CMS-approved registry. Claims-based reporting involves using reporting worksheets. These forms can facilitate claims-based reporting by walking you through the steps to assign the correct code for each measure. The ACR Web site has catalogued these worksheets at www.rheumatology.org/practice/pqri/tools.asp. These worksheets list the appropriate codes, and rheumatologists who choose to participate by reporting quality-measures data through claims can simply report the appropriate quality data codes on service lines of Part B Physician Fee Schedule professional-services claims. Claims-based reporting requires that you submit the quality codes at the same time that you submit the claim for professional services. Medicare has also provided a tip sheet, updated in April, available online at www.cms.hhs.gov/PQRI/Downloads/pqri_satisfactorily508.pdf.
Registry-based reporting requires that providers select a registry that has been approved by CMS as a qualified registry for data collection and submission. This is expected to become the favored method for many providers because they can review the data and add key clinical information concerning the patient at any time. Additionally, providers don’t need to select CPTII codes for registry reporting because the registry performs the measure calculations, and performance data are submitted separately from the billing process.