decisionhealth Newsletters, Answer Books - 2008 Issue 7 (July)
Answer_Book / Quality_Reporting_Initiatives / PQI Old sections / Take_care_with_PQRI_when_Medicare_is_secondary_payer
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Article Overview
This premium article covers a Medicare quality reporting issue involving secondary claims under PQRI. It is aimed at providers, billing staff, and coding professionals who need to understand how CMS treats secondary-payer claims in quality reporting calculations and how claims may need to be handled operationally when more than one payer is involved. The article gives a brief CMS-focused discussion of reporting expectations, participation calculations, bonus payment considerations, and payer communication.
Why This Topic Matters
Medicare secondary claims can still affect PQRI participation and related payment calculations, so practices need to understand the reporting implications before claims are submitted through multiple payers.
Article Sections
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Take care with PQRI when Medicare is secondary payer
Discusses CMS guidance on PQRI reporting when Medicare is not the primary payer. Covers the general handling of secondary claims, participation calculations, bonus payment considerations, and payer communication.
What You Will Learn
- How CMS treats Medicare secondary claims in PQRI participation calculations
- What general claim-handling issue can arise when a primary payer forwards claims to Medicare
- Why payer communication may matter for quality reporting workflows
- How this topic relates to PQRI reporting and bonus payment calculations
Who Should Read This
- Physicians and group practices
- Billing staff
- Coding staff
- Revenue cycle teams
- Quality reporting staff
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