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Incentive Payments Eligible professionals who satisfactorily report quality-measures data for services furnished during a PQRI reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period. Below are the authorized incentive payment amounts for each program year: • 2007 PQRI – 1.5% subject to a cap;
• 2008 PQRI – 1.5%;
• 2009 PQRI – 2.0%; and
• 2010 PQRI – 2.0%. Incentive payments for each program year are issued separately as a single consolidated incentive payment in the following year. Incentive payments are issued to the first valid group location listed under the Taxpayer Identification Number (TIN); or, for solo practitioners, to the first valid practice location listed under the TIN. The Carrier or A/B MAC will make the payment electronically or via check, based on how the TIN normally receives payment for Medicare Part B PFS covered professional services furnished to Medicare beneficiaries. If a TIN submits claims to multiple Medicare claims-processing contractors (Carriers or A/B MACs), each contractor may be responsible for a proportion of the TIN incentive payment equivalent to the proportion of Medicare Part B PFS claims the contractor processed during the applicable reporting period. (Note: If splitting an incentive across contractors would result in any contractor issuing a PQRI incentive payment less than $20 to the TIN, the incentive will be issued by fewer contractors than may have processed PFS from the TIN for the reporting period). The PQRI incentive payment can be offset by an outstanding debt for the TIN. The incentive payment, with the remittance advice, will be issued by Carrier or A/B MAC and identified as a lump-sum PQRI incentive payment. The electronic remittance advice sends only a 2-character code ("LS" – lump sum). This code will appear in PLB03-1 on the outgoing 835. The paper remittance advice states, "This is a PQRI incentive payment." Once we begin distributing incentive payments for a particular program year and your lump-sum incentive does not arrive or the incentive payment amount does not match what is reflected in your PQRI feedback report, contact your Carrier or A/B MAC (click on the "Help Desk Support" link at left for contact information). Note: The incentive amount may differ by a penny or two from what is reflected in your feedback report due to rounding. PQRI Feedback Reports Each year, the PQRI incentive payment and the PQRI feedback report are issued through separate processes (click on the appropriate "PQRI Program" link at left for information specific to a particular program year). PQRI feedback report availability is not based on whether or not an incentive payment was earned. Feedback reports will be available for every TIN under which at least one eligible professional (identified by his or her National Provider Identifier, or NPI) submitting Medicare Part B PFS claims reported at least one valid PQRI measure a minimum of once during the reporting period. PQRI participants will not receive claim-level details in the feedback reports. Validation of Satisfactory Reporting 2009 PQRI As required by statute, the 2009 PQRI includes validation processes. The determination of satisfactory reporting will itself serve as a general validation because the analysis will assess whether quality-data codes are appropriately submitted in a sufficient proportion of the instances when a reporting opportunity exists. In addition, for those professionals who achieve a reporting rate at or above 80% for each of fewer than three PQRI measures submitted through claims, a measure-applicability validation process will determine whether they should have submitted quality-data codes for additional measures. For information on how the 2009 PQRI measure-applicability validation will be implemented, see the document titled "2009 Measure-Applicability Validation Process for Claims-Based Participation", which is available in the "Downloads" section below. Additionally, see the document titled "2009 Measure-Applicability Validation Process for Claims-Based Participation Flow Chart", which is also available in the "Downloads" section below.
Page Last Modified: 10/27/2009 9:03:07 AM
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