Participation Tools: Medicare Physician Quality Reporting Initiative (PQRI)
The American Medical Association has created tools to assist physicians and other eligible professionals who may elect to participate in the Centers for Medicare and Medicaid Services (CMS) PQRI program. The tools for the claims-based reporting of individual quality measures and measures groups are designed to facilitate the data collection required to report clinical performance data.
Those considering participation in the program should carefully review the PQRI instructions and frequently asked questions posted on the CMS PQRI Web site.
For information related to registry-based reporting of individual measures and measures groups, we also encourage you to directlty contact the registry you have selected.
Participation Tools Disclaimer
These participation tools include measures and specifications (“Participation Tools”). The American Medical Association, the Physician Consortium for Performance Improvement®, its members and other measure and specifications developers (“Measure Developers”) do not warrant that the information contained in the Participation Tools is in every respect accurate and/or complete. The Measure Developers assume no responsibility for use of the information contained in the Participation Tools. The Measure Developers assume no responsibility for and expressly disclaim liability for damages of any kind arising out of the use of, reference to, or reliance on the content of the Participation Tools.
For individual quality measures; Claims-Based Submission:
The AMA has created participation tools for the 131 2009 PQRI measures that can be reported through claims-based submission. Each tool contains three 3 documents, which can be printed out for easy reference, including:
1. Measure description
- Describes the information required to report on the measure and how frequently reporting is required. This may help users determine if it is a measure on which they would like to report.
- A step-by-step tool for clinical use and office/billing staff use. It allows the physician or other eligible professional to record the clinical information required for the measure and subsequently select the corresponding billing code.
- A complete list of ICD-9-CM and CPT® codes to identify patients eligible for the measure. A list of the quality codes (eg, CPT-II codes and/or G-codes) for each measure is also included. Should be used in conjunction with the data collection sheet to determine the appropriate code or combination of codes to be reported.
FOR MEASURES GROUPS; CLAIMS-BASED SUBMISSION:
The AMA has created participation tools for the 6 2009 PQRI Measures Groups that can be reported through claims-based submission. Each tool contains two documents, which can be printed out for easy reference, including:
1. Measure description
- Describes the information required to report on the measures group and how frequently reporting is required. This may help users determine if it is a measures group on which they would like to report.
- A step-by-step tool for clinical use and office/billing staff use. It allows the physician or other eligible professional to record the clinical information required for the measures group and subsequently select the corresponding billing codes.
For measures groups, codes to determine measure eligibility are included in the data collection sheet.
2009 PQRI Program Highlights
- Physicians and other eligible professionals who satisfactorily report data on quality measures for covered professional services furnished between January 1, 2009 and December 31, 2009 will receive an incentive payment equal to 2.0 percent of the total estimated allowed charges for all covered professional services furnished during the reporting period.
- There are 153 measures on which physicians and other eligible professionals can report. Of these 153 measures, 131 of them are available to be reported as individual quality measures via claims-based submission.
- There are a several reporting options available for the 2009 PQRI program. For reporting through claims, physicians and other eligible professionals can submit data on individual quality measures or measures groups. In addition, many individual measures and measures groups can be reported via submission of data through qualified registries, as determined by CMS.
Many of the measures in the PQRI were developed by the AMA-convened Physician Consortium for Performance Improvement® (PCPI), in collaboration with the National Committee for Quality Assurance (NCQA) and/or a medical specialty society. For additional information on the PCPI including additional background information on the quality measures with both the rationale and evidence base for each measure, please visit www.physicianconsortium.org.
Questions:
For additional information on the PQRI program, please visit the CMS Web site at http://www.cms.hhs.gov/pqri.
Send an e-mail for questions or comments on the participation tools.
View the 2009 PQRI Individual Measure Tools
View the 2009 PQRI Measures Group Tools
If you are still submitting claims for services provided in 2008, you can access the tools for the 2008 PQRI Measures by clicking the link below.