PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI) PROGRAM FOR PATHOLOGY
BACKGROUND AND 2009 PROVISIONS:
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).The Tax Relief and Health Care Act (TRHCA) of 2006 authorized CMS to pay an incentive to eligible health care professionals who voluntarily report certain quality data to CMS as a part of the PQRI Program. Congress extended PQRI under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which continues the program indefinitely and increased the incentive that eligible professionals can receive for satisfactorily reporting data from 1.5 percent to 2.0 percent of their covered professional charges in 2009 and 2010.
REPORTING
The 2009 PQRI quality measures for pathology remain unchanged from 2008. The two pathology-specific performance measures require pathologic staging and histologic grading for breast and colon malignancies.- Breast cancer patients'pathology reports must have pT and pN categories and histologic grading (excluding biopsies)
- Colorectal cancer patients'pathology reports must have a pT and pN category and histologic grading (excluding biopsies)
PARTICIPATION
Participation in this program is voluntary and there is no need to register to begin reporting. Eligible professionals can participate by reporting the appropriate quality measure data to Rand who will add this data to Medicare claims.
Pathologists who successfully report on 80 percent of all applicable measures will earn an incentive bonus of 2.0 percent of total allowed charges on all 2009 Medicare claims for services paid under the Medicare Physician Fee Schedule. The bonus for reporting in 2009 will be paid mid-2010 on all claims identified with the National Provider Identifier (NPI) of successful reporters.
It is the responsibility of the pathologist to provide Rand with the required measurement data in a form or format that will allow for complete reporting. A recommended reporting form is attached. Retroactive submittal of quality codes is not permitted.
Additional information can be found on the CMS PQRI website at www.cms.hhs.gov/pqri. Call Marvin Retsky, M.D. or Jane Barnes, Director of Client Services, at 805.578.8300, or email mir@randmedical.com or jane@randmedical.com if you have any additional questions.