2007 Physician Quality Reporting Initiative (PQRI) Update

Important Information About the Use of the National Provider Identifier (NPI)

PQRI participants must use their NPIs correctly for their quality-data submissions to count toward successful reporting.

In recent NPI related communications, CMS indicated that since October 15, 2007, Medicare is sending informational warnings that indicate there was no NPI shown in the primary provider fields on your claim(s).  Medicare is including these informational warnings on your pre-pass reject reports provided to you directly or to your bulletin board.

Medicare informational warnings called “Provider Identification Code Qualifier Invalid Value” messages will be labeled M389, M390, M391, and/or M392, but, again, these are only reminders.  If you receive one of these messages, your claim did not include an NPI as required for PQRI reporting.  If you are certain that your claim was submitted with an NPI, you may want to contact your clearinghouse or billing agent to ascertain the reason behind the message.  It is possible that the clearinghouse or billing agent removed the NPI prior to submitting the claim to Medicare.  You may also want to call your carrier/MAC to ask about the message and how you can correct future claims.

PQRI Participation and Coding Tips

The Centers for Medicare & Medicaid Services has developed a Tip Sheet to assist eligible professionals participating in PQRI with reporting accuracy.  Successful participation in PQRI is dependent on accurate submission of information provided on Medicare claims.  This new resource provides helpful tips on the PQRI reporting process and is available on the PQRI web page at: http://www.cms.hhs.gov/PQRI/Downloads/2007PQRITipSheet.pdf. 

Other PQRI Resources

New information is continually added to the most reliable source of information about PQRI, the CMS website: http://www.cms.hhs.gov/PQRI.  Here you will find new and revised Frequently Asked Questions (FAQ), updates on issues related to both the 2007 and 2008 PQRI, new educational products, and access to the latest information you need to successfully participate in PQRI.  Many of the FAQs have been recently updated, so be sure to check the website if you have any questions.

Two of the newest FAQs are:

8691 –

Question:  Where do I place the Physician Quality Reporting Initiative (PQRI) quality-data codes on the CMS-1500 claim form?

Answer:  The 2007 PQRI quality-data codes are HCPCS codes and reporting requirements for these codes follow current rules for reporting other HCPCS codes (e.g. CPT Category I codes).  For additional information, see FAQ #8255.

8687 –

Question: Are Medicare patients who are covered under Railroad Retirement Benefits and Postal Worker benefits included in the Physician Quality Reporting Initiative (PQRI)?

Answer:  Yes.