AMA CPT® Assistant - 2007 Issue 8 (August)
Measuring Up: A Quick Primer for the Physician Quality Reporting Initiative and CPT Category II Codes (August 2007)
August 2007 pages 1-6 Measuring Up: A Quick Primer for the Physician Quality Reporting Initiative and CPT Category II Codes The Tax Relief and Health Care Act of 2006 mandates establishment of a physician quality reporting system and the authorization of a payment incentive to be included as part of the program. The Physician Quality Reporting Initiative (PQRI), formerly known as the Physician Voluntary Reporting Program (PVRP), is the Centers for Medicare and Medicaid Services (CMS) response to the signing of the 2006 legislation. This article is intended to provide readers with information on this new incentive offered by...
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Article Overview
This article explains the early Physician Quality Reporting Initiative (PQRI), the CMS and AMA resources tied to the program, and the role of CPT Category II and selected HCPCS G codes in quality reporting. It is aimed at physicians, health professionals, and coding staff who need a high-level understanding of the program structure, supporting web resources, and claim submission context for the 2007 reporting period.
Why This Topic Matters
The article helps readers orient themselves to a new federal quality-reporting program and the related code framework without having to sort through program materials from multiple organizations.
Article Sections
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August 2007 pages 1-6
Publication placement and article span information.
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Introduction to PQRI
Background on the federal quality reporting initiative, its purpose, and its relationship to CMS and broader quality measurement efforts.
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PQRI program overview and participation resources
General program components, supporting web resources, and the types of materials made available to help users participate in the initiative.
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CPT Category II Code Information
Overview of the supplemental CPT code category, its organization, and its relationship to quality measurement and reporting structure.
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Diagram A: Category II Code Sections on the Web and in the Codebook Documents
A visual guide to the structure and placement of Category II code information in reference sources.
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Diagram B: Appendix H
A visual guide to the Appendix H cross-reference structure and how it supports locating measure-related information.
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AMA Web site resources and source files
A description of the CPT-related online sources and file formats used to present the Category II material for the program.
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CMS reporting guidance and claim form placement
General discussion of how performance-measurement reporting information is entered on claims and where related reporting elements appear on the form.
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Category II Code listing and Appendix H
Closing summary of the article’s purpose, along with notes about keeping up with program updates and related claim processing considerations.
What You Will Learn
- What the PQRI program was designed to support
- How CMS and AMA resources were organized for the program
- How CPT Category II codes fit into quality reporting
- What kinds of supporting reference materials were associated with Appendix H and online resources
- What general claim-reporting context surrounded performance measurement submissions
Who Should Read This
- Physicians
- Other eligible health professionals
- Coding and billing staff
- Practice administrators
- Quality reporting staff
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