From the Practice Directorate

Medicare’s voluntary quality reporting program, known as the Physician Quality Reporting Initiative (PQRI), has been expanded for 2008. Newly added measures give psychologists who wish to participate in the PQRI greater opportunity to earn bonus payments from Medicare.

Medicare Reporting Program Adds New Measures for 2008

Medicare’s voluntary quality reporting program, known as the Physician Quality Reporting Initiative (PQRI), has been expanded for 2008. Newly added measures give psychologists who wish to participate in the PQRI greater opportunity to earn bonus payments from Medicare.

The PQRI provides a financial incentive for health care professionals to report on select measures when filing claims for Medicare services. Providers earn bonus payments by reporting on the program’s measures, regardless of treatment outcomes.

Psychologists can use a measure if they bill for a service identified in the measure. For example, in 2008, a psychologist conducting and billing for a diagnostic interview or a health and behavior assessment service will be able to report whether or not the Medicare beneficiary was screened for cognitive impairment.


What’s New for 2008

The Centers for Medicare and Medicaid Services (CMS) implemented the PQRI on July 1, 2007 as a result of the Tax Relief and Health Care Act of 2006. Psychologists were limited in their participation since only one of the 74 measures for the 2007 program related to mental health. The measures for 2007 were required by statute and taken almost exclusively from a previous voluntary reporting demonstration program limited to physicians.

The one measure for 2007 involved reporting on patients who suffered from major depressive disorder (MDD) and had been prescribed, or at least evaluated for, the use of antidepressant medication during the acute phase of MDD. This measure was not applicable if the psychologist was treating patients with other mental health problems or if the service involved assessment, psychological or neuropsychological testing or health and behavior services.

The Practice Directorate actively sought additional measures to enhance the opportunity for interested psychologists to participate in the PQRI after 2007. The final rule from CMS for the 2008 Medicare fee schedule includes three new measures for the 2008 PQRI program developed by a work group of psychologists and social workers.

The new measures for 2008 involve:

  • reporting on patient co-development of a treatment plan/plan of care (where the provider develops a treatment plan in collaboration with the patient)

  • screening for clinical depression

  • screening for cognitive impairment

In addition, two other measures created by psychiatry involving the diagnosis of depression and assessment of the risk of suicide may also be available to psychologists. APA reviewed the measures and requested that additional billing codes be added to the measures to ensure that psychologists could use them. We will advise practitioners of pertinent updates regarding the use of these two additional measures for 2008.


Reminders About Participating in the PQRI

Participants in the PQRI must be enrolled as Medicare providers and have a National Provider Identifier (NPI). The PQRI does not require separate enrollment.

A few important reminders for participating practitioners:

  • A provider must report on 80 percent of applicable cases to qualify for the 1.5 percent bonus payment. Participating practitioners are encouraged to report on as many measures as possible and to start as early in the reporting period as possible.

  • The 1.5 percent bonus payment applies to all of your Medicare claims, not just the ones you report on under the PQRI. That means you receive 1.5 percent extra payment for all the claims that Medicare pays you for.

  • The deadline for filing claims for the 2007 PQRI is February 28, 2008. Bonus payments for the 2007 reporting period should be made by the summer of 2008.

Contact your local Medicare carrier for more information about the reporting and payment processes, and other aspects of the PQRI. Information is also available on the CMS Web site at www.cms.hhs.gov/pqri.


Looking Ahead

A work group consisting of four APA members is creating additional measures for use by psychologists in 2009, assuming the PQRI will continue beyond 2008. Further, APA will be actively involved with several other organizations that are developing measures for the PQRI, including the Physician Consortium for Performance Improvement and the AQA Alliance.