There are 20 PQRI measures out of the 175 total measures that pertain specifically to rheumatology. Within those 20 measures are two measure groups: the RA measure group that includes six measures and the back pain measure group that includes four.
Providers who choose to report individual measures for PQRI must select at least three measures to report on and must report those measures for at least 80% of applicable patients. “Applicable patients” are those for whom claims are submitted to CMS that include the measure denominator codes.
Providers who choose to report measure groups must report all of the measures in the group for each patient; however, measure-group reporting provides the possibility of reporting on a predictable, defined number of patients. Therefore, measure-group reporting is often considered less burdensome. A list of 20 measures and groups most relevant to rheumatology can be found at www.rheumatology.org/practice; there is also guidance on how to read and interpret the PQRI measure specifications.
Time Frame for Reporting
The PQRI program offers two different reporting periods; the provider must select a period and successfully complete the reporting requirements during that period. Table 1 provides an overview of PQRI reporting requirements for 6-month and 12-month reporting.
Payment
A qualified provider that successfully reports on PQRI measures can receive incentive payments of 2% of the total Medicare Physician Fee Schedule–allowed charges for services provided during the 2010 reporting period.
Incentive payments are available for successful PQRI reporting for up to four years, ending in 2015. If you participate, CMS will issue a feedback report stating whether or not an incentive was earned. However, reports will not provide claim-level details. Beginning in 2015, providers who are not successfully participating in PQRI will incur a negative Medicare payment adjustment of –1.5% for their covered services.
Does the ACR Have Resources to Help?
Providers and practices that are organized and determined can benefit from the self-assessment and bonus payments included in the PQRI program. The ACR offers numerous resources to support your practice as you engage in the PQRI reporting process.
Visit www.rheumatology.org/practice and click on “Office Support,” or contact ACR staff at (404) 633-3777 with questions about PQRI and how your practice can successfully report and attain the 2% incentive payment.
Don’t forget to check out this month’s Coding Corner for a PQRI measure coding example!
