How to Report PQRI for Medicare Advantage

Physicians can receive incentive pay by volunteering for certain reporting programs with Medicare. The Physician Quality Reporting Initiative allows for eligible professionals to send in report data on quality measures (instances where quality care was given and assigned a value number). Eligible participants can choose different claims-based and registry reporting options that are submitted to the Centers for Medicare and Medicaid Services. Although Medicare Advantage beneficiaries do not qualify for PQRI incentive claims-based pay, physicians can include these beneficiaries under registry reporting depending on special circumstances.

Instructions

• 1

  Check the list of eligibility requirements for participation. Covered professionals who receive payment based on the Medicare Physician Fee schedule are eligible. These professionals include occupational therapists, clinical social workers and Medicare physicians such as a doctor of optometry. Visit the Centers for Medicare and Medicaid Services website at cms.hhs.gov/PQRI for a listing. Not every facility can apply since they are reimbursed by Medicare through other services or physician fee schedules, such as providers using Medicare fiscal intermediaries/MACs claims processing systems.

• 2

  Decide which PQRI registry-based reporting will best suit your practice. Choose reporting of measures for an individual eligible patient with a particular medical episode documented, or the reporting of measures groups with 15 to 30 clinically related patients within a similar diagnosis group. Select a reporting period in which you will participate in the voluntary program, from six months or 12 months.

• 3

  Evaluate the PQRI measures list to decide on which measures you will base your reports. Pick at least three applicable measures for individual measures or select at least one measures group when submitting for incentive payment.

• 4

  Review the PQRI Measure Specifications Manual for Claims and Registry and print out the required pages based on your choice of reporting the measures. Read the PQRI Implementation Guide for information regarding how to make the report and fill out the sample claim that uses the basic formatting similar to a CMS-1500 form.