Physician Quality Reporting Initiative (PQRI) undergoes changes for 2011

authored by added January 24, 2011 23:42 by Matt Sluzinski

The Physician Quality Reporting Initiative (PQRI), which we recently discussed in a pmFAQtory blog post, underwent some important changes for 2011.

For starters, the name has changed to Physician Quality Reporting System (PQRS), and the incentive payment to eligible providers has been cut in half, from 2 percent to 1 percent of total Medicare Part B allowed charges.

Due to its inclusion in the Patient Protection and Affordable Care Act of 2010, also know as the health care reform law, the PQRS program is here to stay — but is slowly being shifted from a “bonus payment” program to one that penalizes providers who don’t participate.

Consider the planned trend for PQRS incentive payments:

  • 2010: 2 percent bonus

  • 2011: 1 percent bonus

  • 2012-2014: 0.5 percent bonus

  • 2015: 1.5 percent penalty

  • 2016 and beyond: 2 percent penalty

The penalties, which are set to begin in 2015, will presumably be withheld from a provider’s reimbursement payments. Reducing, via these penalties, the already-low Medicare reimbursements will only further squeeze providers, so if your organization isn’t participating in the PQRS, contact pmFAQtory and let’s talk about how we can help you get started.

Other significant changes to PQRS in 2011 include:

  • For claims-based reporting of individual quality measures, providers only need to report on 50 percent of eligible cases (down from 80 percent).

  • For 2011-2014, eligible providers will be able to receive an additional 0.5 percent incentive payment, on top of the standard 1 percent payment, by participating in a “maintenance of certification” program. More details are in this PDF from the Centers for Medicare and Medicaid Services (CMS).

  • The release of a revised list of quality measures; you can find an updated list and notes from CMS in this ZIP file.

The PQRS is complicated. pmFAQtory offers you expert guidance as you work to implement or refine PQRS in your practice. Contact us today.

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