Medicare's Physician Quality Reporting Initiative (PQRI) can be "found money" for physicians who participate in the Initiative. The program went live in 2007, with just 74 measures available for reporting. It is the government's first step into the "pay for performance" paradigm. Incentive payments of up to 2% of what Medicare paid in the applicable period apply! For many practices, that amounts to tens of thousands of dollars! Originally the payment was just 1.5% of the total Medicare revenue received by the physician; and physician had to demonstrate 80% compliance. The incentive payment has increased, and the compliance requirements have diminished. PQRI rewards doctors for simply reporting quality measures.
PQRI is not mandatory, so what's required to "play"? Physicians have to register and then submit proper claims.
In 2009, PQRI paid out roughly $92 Million to more than 85,000 doctors and other eligible professionals who reported the necessary quality data to Medicare, about $1,000 per physician. Practically speaking, PQRI participation is something driven by billing/coding specialists in practices.
That said, nearly 45% of physicians who participated in PQRI received nothing due to incorrect and insufficient data submission. The advice and guidance of expert billing/coding staff is essential to obtain maximum benefits. Some physicians elect to use registries (at a cost of a couple hundred dollars) that compile and coordinate physician reporting. A list of approved registries can be found at: http://www.cms.hhs.gov/PQRI/Downloads/QualifiedERegistriesPhase1eRx020110.pdf
Incentive payments for successful participation in 2010 will be issued in July, 2011.
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With over 20 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians, Mr. Cohen's practice immerses him in regulatory, contract, corporate, compliance and employment related matters. As Founder of The Florida Healthcare Law Firm, he has distinguished himself and his firm for providing exceptional legal services with the right pricing, responsiveness and ethics.
