The Physician Quality Reporting Initiative (PQRI) is a voluntary pay-for reporting program in Medicare. It offers a financial incentive to physicians and other eligible professionals (EP’s) who successfully report data on quality measures related to services provided under the Medicare Physician Fee Schedule between January 1 and December 31, 2010.

Eligible Providers (EP’s) include physicians and other professionals (e.g., physician assistant’s, nurse practitioner’s, chiropractor’s, physical therapist’s) who provide services paid under the Medicare Physician Fee Schedule.

A PQRI participant who reports successfully, will be eligible for a bonus payment of 2.0 percent of the total Medicare Physician Fee Schedule allowed charges for services provided during the reporting period. In addition, participants will receive confidential feedback reports on the data reported. CMS (Centers for Medicare and Medicaid Services) will provide confidential feedback reports to PQRI participants in mid-2011. Quality data reported under the 2010 PQRI will be publicly reported.

Registration is not required. To participate in the 2010 PQRI, physicians and other eligible professionals need to select the quality measures applicable to their patient panels and report on these measures by submitting the specified quality data codes on claims for services paid under the Medicare Physician Fee Schedule and provided between January 1 and December 31, 2010.

There are 153 quality measures and 7 measures groups in the 2010 PQRI program. For a complete listing, see: www.cms.hhs.gov/pqri

To be eligible for the bonus payment, a participant must report on at least three quality measures for at least 80 percent of the cases in which the measure was reportable. If, however, it is determined that reporting occurred less that 80 percent of the time for any one of the selected measures, the participant would be ineligible for the bonus payment. Participants only having one or two applicable quality measures are still eligible for the bonus if they report on those measures at least 80 percent of the time.

Participants who successfully report in the PQRI may earn a 2.0 percent bonus. The bonus is based on total allowed charges for covered professional services billed under the Physician Fee Schedule furnished during the reporting period. Claims must reach the National Claims History (NCH) file by February 28, 2011. The potential 2.0 percent incentive payment will be paid in mid-2011 as a lump sum bonus payment made to the practice at the Taxpayer Identification Number(TIN) level.

Participation is voluntary in 2010; however, there is a good chance that Congress may make participation mandatory in the future. The PQRI is a first step toward linking Medicare health professionals’ payments to quality, which is expected to evolve over time into a value-based purchasing or pay-for-performance program. Review the quality measures to see which are applicable to your practice. See if there are measures you could start reporting on by January 1, 2010. Start to think about the changes you would need to make to report this data. To get a sense of your potential bonus, look at your total Medicare claims submitted during January 1 – December 31, 2010 and multiply by 2.0 percent.

The PQRI is a first step toward linking Medicare health professionals’ payments to quality, which is consistent with Medicare’s ongoing transformation from passive payer to active purchaser of high-value health care.