Physician Quality Reporting Initiative (PQRI) Program Update – 2009 PQRI Incentive Payment Distribution

Eligible professionals (EPs) who participated in the 2009 Physician Quality Reporting Initiative (PQRI) and are incentive eligible can expect 2009 PQRI incentive payments to be distributed this fall (2010).

Remember that PQRI incentives earned by individual participating physicians and other EPs are paid as a lump-sum to the Taxpayer Identification Number (TIN) under which the EP’s claims were submitted. It is then up to the TIN to decide how to distribute the incentive within the practice. 

Determining the Incentive The analysis of satisfactory reporting for PQRI was performed at the individual EP level for each TIN/NPI, using the individual-level National Provider Identifier (NPI) to identify each professional’s services and quality data. CMS reviewed and analyzed data reported to determine satisfactory reporting and eligibility for an incentive payment based on a percentage of Medicare Part B Physician Fee Schedule (PFS) total estimated allowed charges for covered services furnished during the reporting period. This analysis also determined the incentive payment amount, which was 2 percent of the EP’s Medicare Part B Physician Fee Schedule (PFS) total estimated allowed charges.

For EPs who submitted claims under multiple TINs, CMS grouped claims by TIN for analysis and payment purposes. As a result, a professional who submitted claims under multiple TINs may have earned a PQRI incentive under one of the TINs and not the other(s), or may have earned an incentive under each TIN. The PQRI financial incentive earned by any individual professional under a given TIN, based on the claims associated with that TIN, is included in that TIN’s aggregate PQRI incentive payment

In the event the EP satisfied reporting criteria for multiple 2009 options (including participation via multiple registries) or multiple periods, the EP earned only one incentive payment for the longest or most advantageous reporting period for which satisfactory reporting was achieved.

Feedback Reports CMS aims to distribute feedback reports as closely as possible to the incentive payment timeframe. 2009 PQRI feedback reports will be distributed in late fall/early winter 2010. TIN-level reports on the Portal require an Individuals Authorized Access to CMS Computer Services (IACS) account. Participants may contact their Carrier/MAC to request individual NPI-level reports via the alternate feedback report fulfillment process.

Resources To access all available educational resources on PQRI please visit, http://www.cms.hhs.gov/PQRI/ on the CMS website. Please visit the PQRI webpage often for the latest information and downloads on PQRI.

Questions? If eligible professionals (EPs) have questions on their feedback reports, including report availability and access, or incentive payment calculation, they should contact the QualityNet Help Desk at 866-288-8912 from 7:00 a.m.-7:00 p.m. CST or via e-mail at qnetsupport@sdps.org.