Physician Quality Reporting Initiative

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

To view the measures or more information regarding PQRI please visit http://www.cms.hhs.gov/pqri/.

In order to participate in the PQRI program you must have or obtain a National Provider Identification Number (NPI)!

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Beginning May 23, 2007 (May 23, 2008, for small health plans), the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered entities may invoke contingency plans after May 23, 2007, and guidance about contingency plans may be found in the Downloads section below.

You can easily receive an NPI number online by visiting: https://nppes.cms.hhs.gov/NPPES/Welcome.do

For more information regarding NPI please visit: http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage

• Important Updates on NPI

• PQRI Measures

• Tools for Successful Reporting

• FAQS

• Recent Articles Related to PQRI and Pay for Performance