Physician Quality Reporting Initiative: 2009 Measures
Starting January 1, 2009 physicians can start reporting 2009 PQRI measures. There are 20 measures that will affect rheumatology practices. The incentive bonus pay for successfully reporting will be 2% of the allowable 2009 Medicare Part B Fee for Service with no cap.
2009 PQRI – Individual Measure Reporting options
Below are the different reporting methods:
Registry-based -- RCR: (options for mid-year PQRI start)
Successfully report three or more measures for a minimum of 80 percent of applicable Medicare Part B FFS patients between January 1 - December 31, 2009.
- or -
Successfully report three or more measures for a minimum of 80 percent of applicable Medicare Part B FFS patients between July 1 - December 31, 2009
Claims-based: (January 1 start date)
Successfully report three or more measures for a minimum of 80 percent of applicable Medicare Part B FFS patients between January 1 - December 31, 2009.
2009 PQRI – Measures group reporting options (including RA)
Registry-based -- RCR: (options for mid-year PQRI start)
Successfully report on a minimum of 30 consecutive patients in the group between January 1 - December 31, 2009 (Medicare and non-Medicare patients allowed; must have at least 2 Medicare patients)
- or choose one of the following 2 options -
Successfully report on a minimum of 80 percent of patients in the group with a minimum of 30 patients between January 1 - December 31, 2009 (Medicare patients only)
- or -
Successfully report on a minimum of 80 percent of patients in the group with a minimum of 15 patients between July 1 - December 31, 2009 (Medicare patients only)
NOTE: For reporting options that include a minimum 80 percent requirement, this means that providers must report successfully for at least 80 percent of their patients to which the measure applies in the given time period. Providers who choose to report on only 80 percent of their patient population for a certain measure must, therefore, report with complete accuracy. Because this would allow no room for error without losing the entire incentive payment, CMS recommends that providers report on more than 80 percent of their patient population for each measure, whenever possible, even up to 100 percent.
Claims-based: (January 1 start date)
Successfully report on a minimum of 30 consecutive patients in the group between January 1 - December 31, 2009 (Medicare patients only)
- or -
Successfully report on a minimum of 80 percent of patients in the group with a minimum 30 patients between January 1 - December 31, 2009 (Medicare patients only)
Claims-based: (option for mid-year PQRI start)
Successfully report on a minimum of 80 percent of patients in the group with a minimum 15 patients between July 1 - December 31, 2009 (Medicare patients only)
Note: The following option is still available for mid-year start:
Successfully report on a minimum of 30 consecutive patients in the group whose visits took place at any time in 2009 (Medicare patients only).
Exclusions
Exclusion modifiers may be appended to a CPT II code (on a claim) OR within a registry to indicate that an action specified in the measure was not provided due to medical, patient, or system reason(s) documented in the medical record. These modifiers serve as denominator exclusions for the purpose of measuring performance. Some measures do not provide for performance exclusions.
Reasons for appending a performance measure exclusion modifier fall into one of four categories:
1P exclusion modifier due to medical reasons
Examples include: not indicated (absence of organ/limb, already received/performed); contraindicated (patient allergic history, potential adverse drug interaction)
2P exclusion modifier due to patient reasons
Examples include: patient declined; economic, social, or religious reasons
3P exclusion modifier due to system reasons
Examples include: resources to perform the services not available; insurance or coverage/payer-elated limitations; other reasons attributable to health care delivery system
8P reporting modifier - action not performed, reason not otherwise specified
