PQRI & Radiology
PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality-reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of eligible Medicare payments.
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by the Centers of Medicare & Medicaid Services (CMS). CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).
In total, for all specialties there are 74 measures included in the 2007 PQRI. However, there are only two measures applicable for radiologists:
1. Stroke And Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports:
Percentage of final reports for CT or MRI studies of the brain performed within 24 hours of arrival to the hospital for patients aged 18 years and older with the diagnosis of ischemic stroke or TIA or intracranial hemorrhage that include documentation of the presence or absence of each of the following: hemorrhage and mass lesion and acute infarction
2. Stroke and Stroke Rehabilitation: Carotid Imaging Reports Percentage of final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed for patients aged 18 years and older with the diagnosis of ischemic stroke or TIA that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement
Both of these two measures need to be reported for 80 percent of all eligible patients (based on qualifying ICD-9 and imaging procedure CPT codes) to qualify for the bonus. Reporting on only one of the two measures will disqualify you from receiving any bonus payments. If you do not provide imaging services related to the cited conditions, you are not eligible to receive bonus payments under the PQRI.
Receiving the full 1.5% bonus is contingent on the volume of Measures reporting. For physicians reporting on three Measures or fewer, as is the case with radiologists the total bonus payout may be below the 1.5 percent maximum due to a statutory cap, based on the total volume of Measures reported. CMS will pay the lower of the 1.5% or the capped bonus amount; the formula for calculating the capped bonus amount is as follows: Total Bonus Payout Under Cap = Total instances of reporting Measures × 300% × national average per measure payment amount (NAPMPA).
The reporting period for 2007 PQRI begins on July 1, 2007, for covered services provided to Medicare beneficiaries between July 1 and December 31, 2007. To participate in the 2007 you must begin by reporting the selected measures by submitting the specified quality-data codes on claims for services paid under the Medicare Physician Fee Schedule and provided between July 1 and December 31, 2007. Registration is not required prior to submitting data for the 2007 PQRI.
Physician performance is not being measured; the bonus is paid simply for reporting a practice's appropriate Measures. The deadline for submitting PQRI eligible claims (dates of service between 07/01/07 -12/31/07) is February 29, 2008.
To facilitate education of providers about PQRI, CMS has created a dedicated webpage with information about this program at http://www.cms.hhs.gov/pqri .