CMS Applies a Validation Process for Reporting 2007 PQRI Measures

(PYA Alert dated January 2, 2008)

As required by the Tax Relief and Health Care Act of 2006 (TRHCA), the 2007 Physician Quality Reporting Initiative (PQRI) will include a validation process. This CMS validation process will focus on those eligible professionals who have reported fewer than three quality measures during the 2007 reporting period.

Those who fail the validation process will not be eligible to
receive the 2007 PQRI bonus payment!

What does this mean for you?

Providers subject to the measure-applicability validation process will be those participants who submit CPT category II codes and G-codes for one or two measures (for at least 80% of their patients) and do not submit data for a third related measure. CMS has indicated the General Measures will be excluded from the measure-applicability validation process.

How is the measure-applicability process performed?

The measure-applicability validation is a two-step process:

Step 1: Clinical Relation Test: When you submit quality data for a measure, it indicates that the measure applies to your practice environment. When the clinical relation test is applied, it assumes that if one measure related to a particular clinical focus area is applicable to your practice, then other closely-related measures in that same clinical area may also apply.

Step 2: Minimum Threshold Test: When practice-reported data is subjected to the measure-applicability validation process, identification of other closely-related measures which were not reported in the practice-data will be identified. In the PQRI process, the provider is accountable for reporting quality code(s) for three or more measures that apply to their clinical area of focus. Therefore, if, during a reporting period, you treated the minimum threshold number* of Medicare patients for a condition to which a certain measure applied, but only reported on two or less of the closely-related measures, then the provider will fail the measure-applicability validation process and will not be eligible to receive the 2007 PQRI Bonus Payment.

*For the 2007 reporting period, the minimum threshold will not be less than 50 patients or encounters for each 2007 PQRI measure.

PYA’s Physician Services and Clinical Compliance professionals can assist you in preparing your organization for ongoing PQRI reporting. PYA is prepared to advise and/or assist in operationalizing both the clinical and coding processes necessary to ensure the successful implementation of the quality focused measures within your physician practice environment.

For more information, please contact Lorraine Larrance at (800) 270-9629

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

back to PYA Alerts