New 2007 Physician Quality Reporting Initiative (PQRI) Educational Resource Expands the PQRI Tool Kit
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) Measure Finder Tool (Version 1.0) is now available as part of the 2007 PQRI Tool Kit ~ Six Steps to Success.
The Measure Finder Tool (Version 1.0) is designed to help eligible professionals and their coding/billing staff to quickly search for applicable measures and their detailed specifications. This tool will allow users to search for applicable measures based on a single code or a combination of codes.
The addition of this new product expands the Tool Kit to six new and existing educational resources that will assist eligible professionals with successful reporting.
To access the Tool Kit, visit, http://www.cms.hhs.gov/PQRI 
, on the CMS Website in the PQRI Tool Kit section. Once on the PQRI Tool Kit page, scroll down to the "Downloads" section.
PQRI Question of the Week
Question: The 1.5% bonus is subject to a cap. How and when will CMS calculate the cap for an individual eligible professional?
Answer: The bonus cap calculation is defined as follows: (the individual's instances of reporting quality data) multiplied by (300%) multiplied by (the national average per measure payment). The third factor, the "national average per measure payment amount" can only be calculated after the reporting period ends because it is equal to (the total amount of allowed charges under the Physician Fee Schedule for all covered professional services furnished during the reporting period on claims for which quality measures were reported by all participants in the program) divided by (the total number of instances where data were reported by all participants in the program for all measures during the reporting period).
Because the "national average per measure payment amount" is not yet available, the following is a hypothetical example:
Example:
Dr. Smith had $400,000 in allowed charges during the PQRI reporting period. The 1.5% potential bonus is $6000. Dr. Smith reported quality data codes in 500 instances. The national average per measure payment amount for 2007 was calculated in CY 2008 and turned out to be $100 ($100 M total national allowed charges claims submitted from July through December, divided by, 1 million instances of PQRI quality data codes being reported in the same time period).
The cap for Dr. Smith is $150,000 (500 x 3 x $100). The bonus paid to Dr. Smith in early CY 2008 is $6,000.
Reference: http://www.cms.hhs.gov/PQRI
Page Last Updated: Monday, 09-Jun-2008 13:34:31 CDT
