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January 25, 2018

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Medical Coding News Archives

Proposed Changes to PQRI Released

July 15, 2010:

The Centers for Medicare and Medicaid Services (CMS) has released its proposed changes to the Physician Quality Reporting Initiative for 2011.


Among the key changes the agency is proposing:

  • Adding 20 new individual measures
  • Increasing the availability of reporting through electronic health records systems (EHRs) by including 12 additional individual PQRI measures in this reporting option to bring the total to 22 measures.  
  • Reducing the reporting threshold for claims-based reporting of individual measures to 50 percent. The current reporting threshold is 80 percent. 


In 2011, eligible providers (EPs) who successfully participate in the voluntary program can earn a 1 percent incentive payment. The incentive payment is based on total allowed charges for covered professional services paid under the physician fee schedule. 


The agency will also be creating a new group practice reporting option (GPRO). This reporting method would allow group practices with fewer than 200 eligible providers to report using this option. Currently, the GPRO is available only to practices with 200 or more EPs. 


The Affordable Care Act of 2010 (ACA) also mandates certain changes, the most significant of which is the potential implementation of payment penalties to EPs who do not participate. Under this proposed change, providers who do not satisfactorily report quality data would be subject to a payment reduction of 1.5 percent in calendar year 2015 and 2.0 percent in calendar year 2016 and thereafter. Other significant changes include:

  • Extending incentive payments for CY 2012 through 2014
  • Providing timely feedback reports. Currently, physicians complain that they cannot determine whether they are meeting the reporting requirements. Subsequently, any necessary changes to their processes cannot be made until it is too late.
  • Developing an informal process that permits CMS to review a determination that the EP did not satisfactorily submit quality data.


Deborah C. Hall

Clinical/Technical Editor



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