What is the “cap” on the 1.5 percent bonus payment?
The cap calculations are derived from two sources: the data submitted by all Physician Quality Reporting Initiative (PQRI) participating Medicare providers plus the information submitted by each PQRI participating individual provider. Thus, we won’t know until after the conclusion of the PQRI when all the data has been received by the Centers for Medicare & Medicaid Services (CMS). CMS will then compute a national average per measure payment amount by dividing the total allowable charges for all procedures on which measures are reported by the total count of measures reported by all participating providers. To determine the bonus cap for each provider, CMS will take this average per measure payment times 3 multiplied by the total count of measures the individual provider submits. Then they will pay the lower of this computed cap or 1.5 percent of the total allowed Medicare charges submitted by the provider. So a practice who reports the most possible measures for the most possible code
