May 2008 Newsletter

PQRI Updates in HARP

By: TechComm Services Manager

Enhancements in Release 2.33 (scheduled implementation date 05/19/08) will give HARP the ability to warn users at the time of charge entry that a charge is eligible for a Physician Quality Reporting Initiative (PQRI) measure. The timing is significant because a PQRI quality-data code must be on the same claim as the relevant CPT service code and must be included on the first claim for the service. These updates will help to ensure that PQRI codes are reported on claims to Medicare for providers participating in the program. Since CMS is offering a financial incentive based on the percentage of eligible charges for which a quality-data code is reported, the enhancements to HARP will make it easier to reach the goal and earn the bonus.

CMS has extensive documentation on the PQRI program and reporting measures for 2008 at http://www.cms.hhs.gov/PQRI. Each measure has a defined combination of CPT codes, diagnosis codes, patient age, and gender that determine whether a service is eligible for a measure. If so, proof of quality care should be reported with a CPT II code on the same claim.

In HARP, the criteria for each measure are stored at the virtual level. Only measures applicable to practices in the virtual need to be set up. Since CMS may add or retire measures in the future, the effective dates for measures are also stored.

The setup at the client level in HARP determines whether PQRI warnings are activated. Charge editing for PQRI can apply to an entire diagnosis category, specific physicians, or physician/location combinations. When a charge is entered into HARP, the program reviews the following charge data to determine if it is eligible for PQRI reporting:

• CPT code
• Diagnosis category of billed insurance, which most likely will be limited to Medicare payers
• Physician
• Location
• Diagnosis code
• Patient’s sex
• Patient’s age
• Date of service
• Place of service

When an entered charge meets the criteria, a message will appear on the Charge screen with a list of PQRI measures for which it qualifies. The charge entry operator will have the opportunity to add the CPT II quality-data code to the ticket for PQRI reporting, ensuring that it is on the same claim as the eligible charge. A tracking code with the charge entry operator code will also be added to tickets when a PQRI warning appears, providing tracking records on whether operators are consistently adding CPT II codes for eligible charges.

Existing reports in HARP are able to provide information on CPT II quality-data codes added to tickets. The Transaction Date Summary can be customized to show the number of charges, tickets, and/or patients with the quality-data codes for a selected time period. The Transaction Report Writer can show the ticket numbers of all tickets with the relevant quality-data codes (and any modifiers) for a selected time period.

Activating PQRI Editing

PQRI editing will be available in the HARP version 2.33 release, which is scheduled for 05/19/08. Manager and Partner clients who are interested in this feature should provide their Quadax Service Consultant with a list or spreadsheet of the PQRI measures that apply to their practice. Fee schedules may need to be updated with the CPT II quality-data codes, which have a charge amount of $0.00 (or $0.01 in some cases). Standalone clients can update their own systems for PQRI. Setup details will be in the release notes for HARP version 2.33.

Clients wishing to activate PQRI editing for the Charge Repository System should contact their Quadax Service Consultant. A custom edit can be developed in the CRS sweep program to prevent eligible charges from being released into HARP without the applicable quality-data code.