2007 PQRI Program

The 2007 Physician Quality Reporting Initiative (PQRI) is applicable only to services furnished on or before December 31, 2007. For information about the PQRI as it relates to services furnished after December 31, 2007, please click on the Overview tab on the navigation bar at left.

This page addresses the 2007 PQRI topics identified below.

General Information: Program Overview

Measures/Codes

Feedback Reports

Validation

Incentive Payments

Resources
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General Information: Program Overview

On December 20, 2006 the President signed P.L. 109-432, the Tax Relief and Health Care Act of 2006 (TRHCA). Division B, Title I, Section 101 of TRHCA authorized the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the PQRI. To view the TRHCA, click on the "Statute/Regulations/Program Instructions" link to the left and go to the "Downloads" section.

For general information about the PQRI program requirements for the 2007 reporting period (that is, July 1, 2007 through December 31, 2007), including 2007 PQRI eligible professionals (EPs), quality measures, the form and manner of reporting, criteria used for the determination of satisfactory reporting, the 2007 PQRI incentive payment, validation, appeals, and confidential feedback reports view "MLN MM5558 – Program Overview – 2007 PQRI," which can be found in the "2007 PQRI MLN Matters Articles" file under the "Downloads" section below.

2007 PQRI Reporting Experience. A report describing the 2007 PQRI reporting experience is available in the "Downloads" section below. This report provides a detailed analysis of the 2007 program. It outlines the issues identified for 2007 and CMS plans for modifications to the analytics for the 2008 PQRI. In addition, CMS will apply these modifications to the 2007 PQRI data and re-run the data. CMS expects that additional eligible professionals will qualify for an incentive payment for both 2007 and 2008 based on these efforts. It is anticipated that these activities will be completed by the fall 2009.

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2007 PQRI - Measures/Codes

The list of 74 PQRI quality measures for the 2007 PQRI, the detailed 2007 PQRI measure specifications, and their corresponding release notes are contained in the zip file, 2007 PQRI Quality Measures, under the "Downloads" section below.
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Feedback Reports

Note: 2007 PQRI Feedback Reports, posted since July 2008 on www.qualitynet.org/pqri, are scheduled to be archived effective June 30, 2009 and will no longer be available to participating eligible professionals (EPs). Archiving is required to create server space for the 2008 PQRI and the 2007 PQRI re-run feedback reports, which became available in October 2009.

2007 PQRI re-run feedback reports were generated only for those EPs who previously did not qualify to receive a 2007 PQRI incentive payment but received a 2007 PQRI incentive payment based on the re-run of 2007 PQRI data.  

2007 PQRI - Feedback Reports Are Available by TIN. If you reported PQRI quality measures for 2007 (at least one valid quality data code), you may access your 2007 PQRI Feedback Report through the PQRI Portal on the Quality Net website. A link to the Quality Net website may be found in the "Related Links Outside CMS" section below. Once on the Quality Net website, click on "PQRI" from the dropdown menu under the "Physician Offices" tab. Once on the "PQRI" page, go to "PQRI Portal" located on the top right of the page and click on "2007 Feedback Reports." A self-service look-up tool is available on the PQRI Portal which allows an eligible professional at the Tax Identification Number (TIN) level to see if their 2007 PQRI Feedback Report is available. Once in the PQRI Portal, go to the "Verify TIN Report Portlet" which is located at the bottom left of the page. Enter the TIN and a message appears that indicates if a 2007 PQRI Feedback Report is or is not available. To access your feedback report, if one is available, you must first register for access through a CMS security system known as the Individual Authorized Access to CMS Computer Services (IACS) to receive an IACS user ID and Password. The IACS user ID and Password are needed to access your feedback report.

To register for an IACS user ID and Password, you will need to determine if you should register under the "Individual Practitioner" role or as an "Organization." Register as an "Organization" if you are a group practice which receives Medicare payments on behalf of its members, or if you are a solo eligible professional who will use one or more employee(s) to access the feedback reports. Note that each "Organization" must designate the individual who will register in IACS on the Organization's behalf. Up to two individuals will be able to access the feedback reports for each organization. One 2007 PQRI feedback report will be prepared for each taxpayer identification number (TIN). The group practice will be responsible for sharing National Provider Identifier (NPI) level information with the appropriate professionals within the group practice. Further information on how to register for IACS, as well as IACS Quick Reference Guides can be found by clicking on the "Individuals Authorized Access to the CMS Computer Services (IACS)" link in the "Related Links Inside CMS" section below.

Physicians and non-physician practitioners must have an approved Medicare enrollment in the Provider Enrollment, Chain and Ownership System (PECOS), CMS' national enrollment database, in order to successfully receive an IACS account. Physicians and non-physician practitioners may update their enrollment information with Medicare by using Internet-based PECOS to submit an enrollment application to their designated Medicare contractor. For more information on the Medicare enrollment process, your reporting responsibilities or Internet-based PECOS, please see the link for “Medicare Provider Supplier Enrollment”, in the “Related Links Inside CMS” section below.

The "2007 PQRI Feedback Report User Guide" which contains information about how to register for and access the 2007 feedback reports, is available in the "Download" section below.

For those professionals who achieved a reporting rate at or above 80% for each of fewer than three PQRI measures, a measure-applicability validation process will determine whether they should have submitted quality-data codes for additional measures.

For information on how the 2007 PQRI measure-applicability validation was implemented, see the "PQRI Measure Applicability Validation Process" document in the "Downloads" section below.

Incentive Payment

Lump-sum incentive payments for satisfactory 2007 PQRI reporting were issued either electronically or via check in July 2008. The "2007 PQRI Incentive Payment Guides" zip file in the "Downloads" section below contains the following guidance on the 2007 incentive payment:

• "A Guide for Understanding the 2007 Physician Quality Reporting Initiative (PQRI) Incentive Payment" – to assist EPs in understanding the payment calculation.

• "Quick-Reference Guide to 2007 PQRI Incentive Payment Support" - to assist EPs with contacting the appropriate Help Desk and linking to reference documents.

Questions about whether an incentive payment was issued to a participant can be directed to the Carrier/Medicare Administrative Contractor (MAC). Telephone numbers are available from the "Provider Center Toll-free Numbers Directory" in the "Related Links Inside CMS" section below.

2007 Re-run Incentive Payment

Only those EPs who previously were not incentive-eligible, and became eligible following the back-end system analysis and re-run of 2007 PQRI data, will potentially receive an incentive payment in November 2009.

User Guide: 2007 Re-Run and 2008 PQRI Feedback Reports. This document and the associated addendum, which is available in the "Downloads" section below, will assist EPs in understanding the 2007 re-run and 2008 PQRI feedback reports.

A Guide for Understanding the 2007 Re-Run PQRI Incentive Payment. This document, which is available in the “Downloads” section below, will assist EPs in understanding the 2007 PQRI re-run incentive payment calculation.

Resources

Several resources were created to assist EPs in the integration of PQRI measurement into their practice and to satisfactorily participate in the 2007 PQRI. The following 2007 PQRI resources are available in the "Downloads" section below:

• 2007 PQRI Tip Sheets and Fact Sheets - a zip file containing an overview of the 2007 PQRI and tips on accurate submission of all information required for selected PQRI measures on Medicare claims for services furnished to Medicare Fee-for-Service beneficiaries.

• 2007 Coding for Quality Handbook and Data Collection Worksheets – a zip file containing 1) a handbook delineating coding and reporting principles and providing implementation guidelines for how to satisfactorily report measures using clinical scenarios, 2) measures-specific worksheets that walk the user step-by-step through reporting for each measure. These worksheets were intended for use by the professionals on a concurrent basis to collect PQRI data, and 3) errata sheets for the respective documents containing corrections or changes identified after the document was originally posted.

MLN Matters Articles. Additional information on the PQRI and on how to participate can also be found in the 2007 PQRI MLN Matters Articles. All MLN Matters Articles related to the 2007 PQRI are available in the "Downloads" section below.