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March 27, 2018


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Medical Coding News Archives

CMS Makes PQRI Participation Easier

 
May 13, 2008:
The Centers for Medicare and Medicaid Services (CMS) has made revisions to the Physician Quality Reporting Initiative (PQRI) program that should make participating and meeting the reporting threshold easier for providers—which in turn should make your receiving the 1.5 percent incentive payment more likely.

Under the revisions, which were authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSE), there are now two reporting periods and alternative criteria for reporting measures, as well as measure groups for reporting and expanded registry-based reporting methods.

The two reporting periods are the previously defined January 1 through December 31, 2008, and the newly defined July 1 through December 31, 2008. If the reporting criteria are met, the incentive payment will be based on Medicare allowed charges for the specific reporting period the provider has selected to use. For example, if the provider elects to report the six-month reporting period, the incentive payment will be based on the allowed Medicare charges for July1 through December 31.

Providers may now also report “measure groups.” CMS has created the following four groups:
  • Diabetes mellitus
  • End-stage renal disease
  • Chronic kidney disease
  • Preventive care
These groups contain at least four individual measures. Measure groups may be submitted using either the claims-based or registry-based method. Under the claims-based method, measure groups may be reported only for the six-month reporting period. Under the registry method, the 12-month reporting period may be used since this method allows retrospective review.

Providers may also meet the reporting threshold by using the alternative criteria, which involve the reporting of measure groups. A provider indicates the beginning of “consecutive patients” by reporting the appropriate HCPCS Level II G code on the fist claim. Under the registry reporting method, the provider may elect to use either the six- or 12-month reporting period. For the 12-month reporting period, the measure group must be selected for 30 consecutive patients; for six months, the measure group must be submitted for 15 consecutive patients.

For claims-based reporting, this alternative method applies only for the July 1 through December 31 reporting period. Consecutive patients are defined next in order. Patients are considered consecutive without regard to gender even though some measures in a group (preventive care measures) may apply only to male or female patients.

It is also important to remember that even though the year is almost half over, a provider may qualify for the January 1 through December 31 reporting period. Sixty of the 119 quality measures needed to be reported only once during the reporting period. For example, quality measure 1, hemoglobin A1c poor control in type 1 or 2 diabetes mellitus, requires that the appropriate quality code for the most recent hemoglobin A1c level be reported only once during the reporting period.

Deborah C. Hall
Clinical/Technical Editor

 

 
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