How to Earn Your PQRI Bonus

My last two blogs addressed the ‘what’, ‘when’ and ‘why’ aspects of PQRI (if you haven’t yet read them, you may want to do so prior to reading today’s blog). Today’s blog focuses on the issue of how a health care provider can obtain a PQRI bonus.

You are not required to formally register in order to participate with PQRI. Instead, to be eligible for PQRI’s pay for performance bonus, you need only begin reporting certain information in the context of your claim submissions. These quality measure data (e.g., has provider prescribed beta blocker therapy when appropriate?; has provider performed an annual optic nerve evaluation for each patient suffering from primary open angle glaucoma?; etc.) must be reported via the inclusion of certain CPT Category II codes and G-codes, which are identified in the specifications for the 2007 PQRI.

As to the frequency of reporting, Medicare elaborates on the requirements as follows: “In order to satisfactorily meet the requirements of the program and receive the bonus payment, certain reporting thresholds must be met. When no more than three quality measures are applicable to services provided by an eligible professional, each such measure must be reported in at least 80% of the cases in which the measure is reportable. When four or more measures are applicable to the services provided by an eligible professional, the 80% threshold must be met on at least three of the measures reported.”

If you spend some time considering the effort you must expend (if you are working alone) to obtain a relatively minimal bonus, you may conclude that your time can be better spent doing other things. Nevertheless, if you are able to obtain assistance from your technological resources (e.g., EMR) or from your billing partner, you should seriously consider PQRI. In addition to earning a bonus, you will be focusing even more intently upon systematically delivering superior medical care to your patients and you will be ready for 2008 and 2009 PQRI and the bonuses associated with these initiatives will likely be even greater than those available this year.

Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances

Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances