To register your intent to participate with PQRI using CINA PQRI Reporting, click here.
As a CMS Qualified Registry for PQRI Reporting, CINA can report measures on behalf of the provider to CMS on an annual basis, eliminating the need for claims-based reporting of PQRI codes and significantly increasing reporting success.
Highlights of the CINA PQRI Registry system include:
- One-time annual submission, eliminating the need to match PQRI codes to specific claims
- Automated data extraction, standardization and analysis, eliminating the need for manual data entry or provider intervention into the reporting process
- Reporting on the population as a whole, making it as easy to report on all eligible patients seen in a given year as to report on a subset of patients
- Reporting on a wide range of applicable measures, which provides the practice with a more robust picture of practice patterns
- Full spectrum of available measures, including all new measures for the current year that are applicable to the provider’s patient base as well as additional measures as appropriate for reporting needs
CINA offers Individual Measures Reporting, which requires at least three measures to be reported on 80% of the patient population eligible for those measures. As a registry, CINA electronically extracts data for both the measure denominator and numerator, thus significantly improving the reporting percentage which is the basis for bonus payment currently.
Further, CINA offers a comprehensive set of measures from which to select and allows providers to elect as many measures as appropriate at no additional charge, thus delivering a more comprehensive evaluation of practice adherence to guidelines.
PQRI: Frequently Asked Questions
What is the difference between claims-based and registry-based reporting?
Registry based reporting differs significantly from claims based reporting in two important ways. First, registry reporting is based on the aggregate of the patient population and not by the individual patient or claim. Second, as a registry, CINA is responsible for calculating and reporting both the numerators and denominators for each measure. This information is used to determine the provider’s reporting percentage and performance percentage. Bonus payments are determined solely on the reporting percentage.
In previous years, many providers were unsuccessful with claims-based reporting. This was due to a myriad of factors, including discrepancies between CMS’ calculation of denominators and numerators based solely on claims billing, clearinghouse and intermediary errors in recognizing and authorizing the required CPT2 codes, and billing systems not designed to handle CPT2 codes. These problems are virtually non-issues with registry-based reporting.
What reporting methodologies can registry utilize?
Qualified registries are allowed to report using two methodologies:
- Measure Groups, used primarily by registries, require manual data entry on a specified set of measures on either 15 (half year reporting) or 30 (full year reporting) consecutive patients. Of the patients reported, at least two must be Medicare patients.
- Individual Measure Reporting, used primarily by registries with the ability to abstract data electronically, requires at least three measures to be reported on 80% of the eligible patient population for those measures.
The only registry option that CINA will offer will be Individual Measure Reporting since data abstraction is done electronically.
What constitutes successful PQRI reporting?
Incentive bonus payments are based solely on the reporting percentage. Although no registry can guarantee that a provider will receive a bonus payment, based on complying with the existing registry reporting criteria, CINA anticipates no problems with accurate reporting.
How is the bonus payment calculated?
Bonus payments are calculated at 2% of total Medicare eligible claims. Only Fee for Service reimbursement (billed from the physician fee schedule) is eligible for inclusion. Medicare Advantage plans are not eligible and practices should not factor that reimbursement in when calculating anticipated bonus payments.
Does CMS monitor the registry reporting process?
As a registry, CINA must maintain a data validation strategy that confirms both accurate and complete data is extracted and reported to CMS. While CMS has the right to audit registry reporting processes, there currently is no defined process established by which CMS will challenge or audit the registry reporting process. CMS has indicated that a gross discrepancy between the number of patients reported and billed claims could trigger some type of audit process. However, to date, this process and the applicable rules have not been published.
What does CMS do with the submitted data?
There are currently two reports generated by CMS for each provider: 1) The Reporting Rate shows the number of eligible patients (denominator) for each measure and the number of reporting instances (numerator). The Reporting Rate determines bonus payment and is based completely on reporting, not performance. The second report is the Performance Rate, which benchmarks the provider against the 25th, 50th, and 75th percentile of all providers reporting for each measure. In addition to the CMS reports, CINA will provide benchmarking reports for both individual providers and the practice as a whole for all measures reported.
Can providers appeal reporting feedback?
There is no indication that there will be any type of appeal process for providers if they disagree with the reporting feedback.
Are there any incentives for e-prescribing and can CINA report this?
Practices now have the ability to receive 2% of allowable Part B billings for reporting e-prescribing on at least 50% of their eligible population in 2009. This is in addition to the 2% bonus for PQRI reporting. However, CINA cannot report e-prescribing for a practice. E-prescribing can only be reported through claims for 2009.
More information on PQRI and registry reporting can be found on the CMS website: http://www.cms.hhs.gov/PQRI/
To register your intent to participate with PQRI using CINA PQRI Reporting, click here.