The Physician Quality Reporting Initiative is a voluntary physician quality reporting system implemented by the Centers for Medicare and Medicaid Services (CMS). PQRI offers participating professionals the opportunity to earn a bonus payment for prospectively entering codes related to specific performance measures. Some specific details of the PQRI program follow.

• There is no registration required to participate. This is a voluntary program and participation begins when you submit your first quality code.
  
• Claims must be submitted with the National Provider Identifier (NPI) number. PQRI reporting and analysis is done at the NPI level. All claims must be submitted with the eligible professional’s NPI number.
  
• If four or more measures are applicable to your practice, you must report on at least three measures for 80% of the applicable patients. If less than three measures are relevant to your practice, you must report on all of the appropriate measures for 80% of the appropriate patients.
  
• PQRI measures are reported using CPT Category II codes or G codes. Additional modifiers specific to the PQRI program may be required.
  

ASCO continues to pursue PQRI reporting options that are relevant to oncology providers.

2008 PQRI Program

In April 2008, CMS released a PQRI program announcement in response to the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). The MMSEA allows more flexibility for reporting under the program, and CMS made the following changes in accordance to the Act:

Eligible professionals who meet the criteria for satisfactory submission of quality measure data for services furnished during the reporting period of January 1, 2008 through December 31, 2008 will earn an incentive payment of 1.5% of their total allowed charges for Physician Fee Schedule services furnished during the reporting period. The "cap" that can limit bonus payments to an amount less than 1.5% for 2007 has been removed for 2008. Therefore, all successful participants will earn the 1.5% bonus payment.

• An alternative reporting period of July, 1, 2008 through December 31, 2008 has been established for providers who report on one of four new measure groups. The measure groups are diabetes, preventive care, chronic kidney disease, and end state renal disease.
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• Registries my now be used for reporting PQRI measures (individual or group measures) in 2008.

More information on the 2008 PQRI changes

2008 PQRI Measures for Consideration by Oncology Providers

2008 PQRI Tools and Worksheets

ASCO National Audiocall on Adapting to Changes in 2008 was held January 9, 2008 and it included information on the 2008 PQRI program. The presentation is available for download.

 

2007 PQRI Program

The 2007 program began on July 1, 2007 and continued through December 31, 2007. CMS reports that data and payments for 2007 PQRI participation should be available to providers in mid-July 2008.

2007 PQRI Measures for Consideration by Oncology Providers (Includes links to PQRI worksheets)

2007 PQRI Tools and Worksheets

Slide presentation for ASCO's National Audiocall on 2007 PQRI

Recorded version of ASCO's National Audiocall on 2007 PQRI

 

Other Resources on PQRI

CMS Website on PQRI

CMS FAQS on PQRI