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Eligible professionals (EPs) do not have to enroll or file an intent to participate in the PQRI program. Professionals who choose to participate by reporting quality measures data through claims can simply report the appropriate quality data codes on service lines of Medicare Part B Physician Fee Schedule (PFS) professional-services claims. Beginning with the 2008 PQRI program year, EPs may also qualify to earn a PQRI incentive by reporting quality measures data to a qualified registry. Professionals participating in a registry that self-nominates and qualifies to submit data on behalf of eligible professionals for a particular program year should expect to receive more information from the registry on how to participate. In addition to the claims-based reporting mechanism and the registry-based reporting mechanism, CMS is testing electronic health record (EHR) data submission, in cooperation with EHR vendors. Pending successful completion of the 2009 EHR Testing Program and a determination that there is at least one "qualified" EHR vendor, then an EP would be able to earn a PQRI incentive payment through the EHR-based reporting mechanism beginning with the 2010 PQRI (if the EP is using one of the EHR products that CMS is "qualifying in its 2009 EHR Testing Program). 2010 PQRI As described in the 2010 Medicare PFS final rule (to view the rule, click on the "Statute/Regulations/Program Instructions" link at left), CMS is retaining the claims-based and registry-based reporting mechanism. In addition, CMS will accept PQRI quality measures data extracted from a qualified EHR product for a limited subset of proposed 2010 PQRI quality measures. This is contingent upon the successful completion of our 2009 EHR Testing Program and a determination that one or more EHR vendors participating in the 2009 EHR Testing Program is "qualified." Registry-Based Submission For 2010 Incentive To qualify to submit data on behalf of EPs seeking incentive payments for 2010, registries are required to go through a self-nomination and vetting process if they are new to PQRI registry reporting or to notify CMS of their desire to continue PQRI data submission in 2010 if they were qualified in 2009 and successfully submitted their users' quality data. To become qualified, registries must meet certain technical and other requirements specified by CMS. The document "Registry Requirements for Submission of 2010 PQRI Data on Behalf of Eligible Professionals" may be found in the "Downloads" section below. This document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2010. This document also outlines how a registry can become qualified for 2010 data submission. A list of qualified registries for the 2010 PQRI will be posted here by December 31, 2009. This list will consist of qualified registries for the 2008 and 2009 PQRI that have successfully submitted 2008 PQRI data on behalf of EPs to us. Additional registries will be added to the list of qualified registries for the 2010 PQRI upon completion of the 2010 registry self-nomination process. We expect to complete the self-nomination process to qualify additional registries for the 2010 PQRI in summer 2010. Draft Documents for 2010 EHR-Based Reporting In the 2010 PFS proposed rule, CMS proposed that ten measures would be available for EHR-based reporting in 2010 (if we finalize our proposal to permit EPs to earn a PQRI incentive payment through the EHR-based reporting mechanism in 2010). The following draft documents for the electronic submission of these ten proposed measures is available in "Draft Documents for 2010 EHR-Based Reporting" zip file in the "Downloads" section below: • Draft 2010 EHR Measure Specifications – The detailed description of data element names and codes related to each of the ten 2010 PQRI quality measures proposed to be available for electronic submission. • Draft 2010 EHR Measure Specifications – Release Notes – The corresponding release notes for the draft 2010 EHR Measure Specifications. • Draft 2010 EHR Code Reference Table - 2010 reference tables containing applicable standardized codes, including but not limited to ICD-9, CPT®, and LOINC®. (This document is split into 19 tables, titled Appendix A through Appendix S. Information contained within the tables of this document is also referred to within the Draft Measure Specifications above.) NOTE: The posting of any documents for the electronic transmission of any particular measure prior to publication of the 2010 PFS final rule does not signify that the measure will necessarily be selected for the 2010 PQRI measure set, nor that EHR-based reporting will be accepted for that measure even if it may otherwise be included in the 2010 PQRI. 2009 PQRI Registry-Based Submission For 2009 Incentive To qualify to submit data on behalf of EPs seeking incentive payments for 2009, registries are required to go through a self-nomination and vetting process if they are new to PQRI registry reporting or to notify CMS of their desire to continue PQRI data submission in 2009 if they were qualified in 2008 and successfully submitted their users' quality data. To become qualified, registries must meet certain technical and other requirements specified by CMS. The document "Registry Requirements for Submission of 2009 PQRI Data on Behalf of Eligible Professionals" may be found in the "Downloads" section below. This document describes the high-level requirements for a registry to qualify to submit under the registry-based reporting alternatives for 2009. This document also outlines how a registry can become qualified for 2009 data submission. The "Qualified Registries for 2009 PQRI" document is available in the "Downloads" section below. This document lists the names and contact information of the "qualified" registries that may submit quality data on behalf of their EPs for a possible payment incentive (to be paid in 2010) for the 2009 PQRI. For each registry listed in the document, there is also information on whether the registry is accepting new EPs, or clients, the individual 2009 PQRI measures and/or measures groups the registry is planning to report, available reporting periods, and whether the registry was a 2008 PQRI registry. 2009 Testing of EHR-Based Reporting As described in the 2009 Medicare PFS final rule, CMS is testing EHR data submission in 2009, in cooperation with electronic health record vendors. These vendors were selected from those who self-nominated per a process described in the 2008 PFS final rule. For 2009, the testing process was similar to the testing process used for 2008 and EHR vendors were invited to self-nominate again through the process outlined below. EHRs that are successful with the 2009 testing process will be "qualified" for possible PQRI data submission via EHRs if this means of data submission is used in a future PQRI reporting year. For the purpose of testing EHR-based reporting during 2009, ten of the 2009 PQRI measures have been specified for EHR-based submission. The "Documents for 2009 Testing of EHR-Based Reporting" zip file in the "Downloads" section below contains the following documents relevant to the 2009 testing of EHR-based reporting: • Requirements for EHR Vendors to Participate in the 2009 PQRI EHR Testing Program – The requirements an EHR vendor must meet for 2009 testing and possible qualification. • 2009 EHR Measure Specifications – The 2009 measure specifications that will be utilized for testing 2009 PQRI data submitted via EHRs in 2009. The specifications are a detailed description of data element names and codes related to each of the ten 2009 PQRI quality measures. 2009 EHR quality measures are documented in the format in which they will be computed once data is submitted to the EHR Warehouse. • 2009 EHR Measure Specifications – Release Notes – The corresponding release notes for the 2009 EHR Measure Specifications. • 2009 EHR Data Submission Specifications Utilizing HL7 (Health Level Seven) QRDA (Quality Reporting Document Architecture) Implementation Guide based on HL7 CDA (Clinical Documentation Architecture) Release 2.0 (updated 7/15/09) – The specifications defining how patient-level quality measure EHR data should be submitted to CMS for the 2009 EHR test. HL7 QRDA is based on HL7 CDA Release 2.0 and is positioned as the upcoming health information technology standard for EHR systems to exchange quality measure data. CMS has decided to implement the QRDA draft standard for trial use in the 2009 PQRI EHR test. (This new Specification will replace the previously posted specifications which were based on HL7 version 2.4, batch messaging.) • 2009 EHR Code Reference Table (updated 7/15/09) - 2009 reference tables containing applicable standardized codes, including but not limited to ICD-9, CPT®, and LOINC®. (This document is split into 19 tables, titled Appendix A through Appendix S. Information contained within the tables of this document is also referred to within either the Measure Specifications or Data Submission Specifications, above.) • 2009 EHR Data Warehouse Errors and Edits Documents – These documents define the error messages (both critical and informational) for 2009 EHR data submitted to the Data Warehouse.
Page Last Modified: 11/05/2009 9:26:45 AM
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