PQRI (Physician Quality Reporting Incentives) was established by CMS in 2006. It is a pay-for-performance (P4P) program for physicians treating Medicare beneficiaries. To be eligible for the bonus, physicians must report on at least 3 measures applicable to their practice and measures must be reported in at least 80% of encounters where a measure applies, between January 1 and December 31, 2009, to receive a bonus of up to 2% of their total Medicare allowed charges for that period. .  The incentive is awarded for reporting on applicable measures, regardless of whether or not the measure was met.

Steps to submit Physician Quality Reporting Initiative (PQRI) quality measures data on claims:

• Use the measure specifications to identify measures applicable for professional services you routinely provide.

• Select those measures that make sense based upon prevalence and volume in your practice as well as your individual or practice performance analysis and improvement priorities.

• Review the measures that you have selected to become familiar with how to apply and correctly code the measures.

• Refer to the PQRI Implementation Guide for more detailed information and reporting tips at http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage.

• Access data collection worksheets on the American Medical Association's (AMA) website to help you implement PQRI in your practice.

• Ensure that your billing software and clearinghouse can correctly submit PQRI quality-data codes (QDCs) on your behalf to the carrier.

• Regularly review the Remittance Advice Notice you receive from the carrier to ensure the denial remark code N365 is listed for each QDC submitted.

  
  

For the selected measures, the detailed coding specifications are available at the CMS site. Each of the measures has a quality data code (CPTN II code or G-code) associated with it, and several CPT II modifiers: generally 1P, 2P, and 3P. To qualify for the incentive, the correct quality data code will need to be reported on at least 80% of the claims that are eligible for each selected measure. A claim is “eligible” when the ICD-9-CM diagnosis and the CPT1 service codes match the diagnosis and CPT1 codes listed for the measure denominator.

2009 E-Prescribing Incentive Program

A prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care is an important element in improving the quality of patient care. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes a new and separate incentive program for eligible professionals who are successful electronic prescribers (e-Prescribers) as defined by MIPPA.  The program began on January 1, 2009 and provides incentives of 2% of a healthcare professional’s estimated total Medicare Part B PFS allowed charges for those who are "successful e-prescribers".

To be considered a successful eprescriber for 2009, you must report an e-prescribing measure on at least 50% of Medicare Part B claims for services furnished during the 2009 reporting period. Also, to qualify to earn the incentive, at least 10% of your total Medicare Part B PFS allowed charges for the 2009 reporting period must be for services listed in the e-prescribing measure’s denominator. The steps to participating in the E-Prescribing Incentive Program are similar to the steps for reporting individual PQRI measures through claims. You can read all about this incentive, how the measure is specified, and how to report the G-codes, including a sample CMS-1500 claim, on the CMS e-Prescribing Incentive Web site at: www.cms.hhs.gov/ERXIncentive/.In 2008, $36 million was paid to health professionals participating in the PQRI program.