On December 20, 2006, the President signed the Tax Relief and Health Care Act of 2006 (TRHCA), which authorized the Centers for Medicare and Medicaid Services (CMS) to establish and implement a physician quality reporting system. In response to the mandate, CMS created the Physician Quality Reporting Initiative (PQRI).
Scroll Below to Learn More About These Topics...
| 2010 PQRI | Feedback Reports & Bonus Incentive Payments |
| 2009 PQRI | Registry Reporting: Ophthalmic Patient Outcomes Database |
| 2008 PQRI | Additional PQRI Resources |
| 2007 PQRI | Need Help? |
2010 PQRI
In its recent final rule on the 2010 Medicare Physician Fee Schedule (MPFS), CMS stated that it would continue implementing quality improvement initiatives for physicians via the PQRI. CMS will include two new quality measures in the 2010 PQRI program that were developed by the ophthalmology community in conjunction with the AMA’s Physician Consortium for Performance Improvement (PCPI). These measures will be available under the registry reporting option (see below). The two measures are
- Measure 191 - Cataracts: 20/40 or Better Visual Acuity within 90 days Following Cataract Surgery (registry reporting only*)
- Measure 192 - Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (registry reporting only*)
In 2010, the following ophthalmic measures will be retained from the previous 2009 PQRI
- Measure 12 – Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
- Measure 14 – Age-Related Macular Degeneration (AMD): Dilated Macular Examination
- Measure 18 – Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
- Measure 19 – Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
- Measure 117 – Diabetes mellitus: Dilated Eye Exam in Diabetic Patient
- Measure 139 – Cataract: Comprehensive Preoperative Assessment for Cataract Surgery with Intraocular Lens (IOL) Placement)
- Measure 140 – Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
- Measure 141 – Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care
Be sure to review the 2010 PQRI measure specifications for detailed instructions on how to report these measures.
2010 PQRI Implementation Guide
*Information about reporting via registry is outlined below under "Registry Reporting: Ophthalmic Patient Outcomes Database."
2009 PQRI
The Medicare Improvements for Patients and Providers Act (MIPAA) of 2008 authorized a 2% bonus for those who successfully report quality measures in the proposed 2009 PQRI.
On December 16, 2008, CMS released the long-anticipated 2009 PQRI measure specifications. The specifications provide detailed instructions on the use of each available measure, including the associated CPT, ICD-9 and quality data codes that must be reported on your CMS-1500 form or electronic equivalent. There are eight measures that are specific to eye care, which are shown below:
- Measure 12: Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
- Measure 14: Age-Related Macular Degeneration (AMD): Dilated Macular Examination
- Measure 18: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
- Measure 19: Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care
- Measure 117: Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient
- Measure 139: Cataracts: Comprehensive Preoperative Assessment for Cataract Surgery with Intraocular Lens (IOL) Placement
- Measure 140: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
- Measure 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care
Feedback reports and bonus incentive payments for the 2009 PQRI will not be available until Fall of 2010.
2009 PQRI Measure Specifications
2008 PQRI
The 2008 PQRI was similar to the 2007 PQRI in that eligible professionals who successfully report a designated set of quality measures on claims for dates of service from January 1 to December 31, 2008, may earn a bonus payment. The bonus payment will be 1.5% for those who successfully report. New measures were added to the 2008 PQRI and others were removed. To learn more about feedback reports and bonus incentive payments for the 2008 PQRI, scroll to "Feedback Reports & Bonus Incentive Payments."
2007 PQRI
The 2007 PQRI allowed eligible professionals who successfully reported on a designated set of quality measures on claims for dates of service between July 1 and December 31, 2007, to earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services. Approximately 109,000 providers participated in the 2007 PQRI, and about half of those who participated earned a bonus. CMS identifed a number of issues with the method used for analyzing PQRI data reprted by eligible professionals. These concerns were addressed to avoid problems in future PQRI programs. Recently, CMS re-ran the "raw" 2007 PQRI data through its updated analytics, which allowed an additional 3900 providers to earn a bonus incentive payment for the 2007 PQRI.
Information about 2007 Feedback Reports and the 2007 PQRI re-run can be found below in "Feedback Reports & Bonus Incentive Payments."
Feedback Reports & Bonus Incentive Payments
Important Information About Accessing 2007 Re-Run and 2008 Physician Quality Reporting Initiative (PQRI) Feedback Reports
CMS would like to remind PQRI participants that there is a “Verify Report Portlet” look-up tool available on the PQRI Portal for Eligible Professionals (EPs) to verify if a 2007 re-run and/or 2008 PQRI feedback report exists for your organization's Tax Identification Number (TIN) or National Provider Identifier (NPI). The TIN or NPI must be the one used by the EP to submit Medicare claims and valid PQRI quality data codes. This tool is available at https://www.qualitynet.org/portal/server.pt on the internet.
If a report is available for your organization’s TIN or NPI there are two ways to access 2007 re-run and/or 2008 PQRI feedback reports:
1) An individual EP can simply call their respective Carrier or A/B MAC provider contact center to request confidential 2007 PQRI re-run and/or 2008 PQRI feedback reports that will contain information based on their individual NPI. If an EP is part of a group practice, each EP in the group practice must individually call their respective Carrier or A/B MAC provider contact center to request a feedback report based on the individual NPI. To obtain a list of Provider Contact Centers, visit http://www.cms.hhs.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip on the CMS website. In addition to PQRI information, these reports will provide individual EPs with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.
Additional information about this alternative feedback report request process can be found by accessing special edition Medicare Learning Network (MLN) article (SE0922) “Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports.” Visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0922.pdf on the CMS website.
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2) EPs can logon to the secure PQRI Portal on QualityNet at http://www.qualitynet.org/portal/server.pt to access their feedback report(s) based their TIN, or for a group. Access to the PQRI Portal requires registration in the Individuals Authorized Access to CMS Computer Services (IACS) system to obtain a userID and password.
Important Information on Updating IACS User Accounts and Passwords
CMS would like to remind users that the CMS Security policy requires IACS passwords to be changed every 60 days. An IACS user who has not changed his or her password in over 60 days will be prompted to do so at the next login attempt.
An IACS user who has not changed his or her password in over 120 days will first be prompted to answer the security questions established at registration. After successfully answering security questions, the user will then be prompted for a password change.
Updating IACS user accounts and passwords is essential to maintaining this access and functionality.
Additional Resources
The IACS account management page is at https://applications.cms.hhs.gov/category.html?name=acctmngmt on the internet. Click on “My Profile” to login, change your password, or use the “Forgot Password?” option.
If you are having difficulty with IACS registration or disabled accounts, follow the self-service instructions below on how to recover your IACS userId and/or password and/or change your IACS password.
Instructions for Retrieving Your IACS UserID
1. Go to the CMS Applications portal at https://applications.cms.hhs.gov
2. Enter the portal; select the Account Management tab, and then the “Forgot Your User ID?” link in the Account Management section. Follow the online instructions.
3. You will receive an email at the email address on record.
Instructions for Retrieving Your IACS Password
1. Go to the CMS Applications portal at https://applications.cms.hhs.gov/warning.html
2. Enter the portal; select the Account Management tab, and then “My Profile” link in the Account Management section.
3. Enter your UserID
4. Click on “Forgot Your Password?” button on the login page and follow the online instructions.
5. You will receive a onetime password in an email at the email address on record.
Instructions to Login and Change Your IACS Password:
1. Go to the CMS Applications portal at https://applications.cms.hhs.gov
2. Enter the portal; select the Account Management tab
3. Select the My Profile link
4. Login using your UserID and onetime temporary Password.
5. The system will prompt you to change your password.
6. Enter your new password in both the New Password and Confirm New Password fields and then select the Change Password button.
7. The system will take you back to the My Profile screen.
8. Log out.
Once you have successfully changed your password you may login and access your PQRI feedback report(s) on the PQRI portal at https://www.qualitynet.org/portal/server/pt on the internet.
If you are still having difficulty with IACS registration or disabled accounts, please contact the External Users Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday – Friday 7:00 a.m.-7:00 p.m. EST) or via e-mail at EUSSupport@cgi.com.
The IACS home page for the Provider/Supplier user Community, which includes PQRI, is at http://www.cms.hhs.gov/IACS/04_Provider_Community.asp#TopOfPage on the CMS website. Provider Community users should direct questions or concerns to the External User Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday - Friday 7:00 a.m.-7:00 p.m. EST) or via email at EUSSupport@cgi.com.
The PQRI Portal is available at https://www.qualitynet.org/portal/server.pt on the internet. Although the “Forgot Password” link on the PQRI Portal sends users to the IACS website; IACS and the PQRI Portal are two separate websites.
Additional information about PQRI can be found at http://www.cms.hhs.gov/PQRI on the CMS website. For more information on the 2007 re-run and 2008 PQRI feedback reports or incentive payments, see the "PQRI and eRx Quick-Reference Support Guide for Eligible Professionals" at http://www.cms.hhs.gov/PQRI/Downloads/PQRI-eRxEPQuickRefGuideDiagram_100209.pdf on the CMS website.
Users who still have questions or need assistance should contact the QualityNet Help Desk at 1-866-288-8912 (Monday-Friday 7:00 a.m.-7:00 p.m. CST) or qnetsupport@sdps.org.
Registry Reporting: Ophthalmic Patient Outcomes Database
The American Academy of Ophthalmology and American Society of Cataract & Refractive Surgery have worked together to bring their members access, at a reduced cost, to a CMS-qualified, web-based registry for collecting and reporting data on PQRI quality measures—called the Ophthalmic Patient Outcomes Database—from Outcome™. Compared with claims-based reporting for PQRI, this database offers a single transmission to CMS at the end of the reporting period, eliminating the need for additional CPT II and G codes. It also allows you to view your data prior to transmission to CMS and provides built-in quality checks that reduce errors. Academy and ASCRS members are eligible for a special discount. Read about the benefits of the Ophthalmic Patient Outcomes Database for PQRI reporting and get pricing information. If you are interested in signing up, please call Outcome™ at 617-715-6898 or e-mail them at ophthalmicdatabase@outcome.com.
We encourage you to sign up for one of the free Outcome webinars, to learn more about reporting quality data codes for the PQRI program through the registry.
Additional PQRI Resources
PQRI Web Training Module
CMS' PQRI Website
CMS' PQRI FAQ's
Need Help?
Three PQRI Help Desk Resources Are Available for Eligible Professionals.
1. Provider Call Center Directory
• Remittance Advice Notices
• Incentive payment distribution status
• Adjustments made to incentive payment due to sanctions/overpayments
Download the "Provider Center Toll-free Numbers Directory"
2. External User Services (EUS) – 7:00 AM – 7:00 PM ET
• Registering/creating an IACS account
• Accessing an IACS account
• Changing an IACS account
• Approving users into an organization
Phone: 1-866-484-8049
TTY: 1-866-523-4759
Email: EUSsupport@cgi.com
3. QualityNet Help Desk – 7:00 AM – 7:00 PM CT
• General CMS PQRI & E-Prescribing Information
• PQRI Portal Password Issues
• PQRI feedback report availability and access
Phone: 1-866-288-8912
Email: Qnetsupport@sdps.org
If you have a specific concern or problem related to the PQRI, please contact the ASCRS Government Relations Department at 703-591-2220 or egraham@ascrs.org.
