Physician Quality Reporting Initiative (PQRI)

On December. 20, 2006, the President signed the Tax Relief and Health Care Act of 2006, mandating establishment of a physician quality reporting system and authorizing a payment incentive. The Centers for Medicare and Medicaid Services (CMS) has titled the statutory program the Physician Quality Reporting Initiative (PQRI).

PQRI authorizes 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, 2007 through December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services.

Note that this initiative applies to the traditional Medicare fee-for-service program only and is not applicable to the Medicare Advantage Plans, including the private fee-for-service plans.
Eligible professionals need not enroll or file an intent to participate for the PQRI. Eligible professionals can participate by reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor.

CMS has discontinued PVRP and will be replacing it with the PQRI program.

Questions?

For more information contact Terrey Currie, Project Assistant, at 303-784-5732, TCurrie@cfmc.org.

The Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS Policy.