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Why This Topic Matters

Practices needed to know how quality-reporting claims would be handled across primary and secondary payer systems so they could avoid disruptions to claim processing and meet Medicare’s quality-reporting participation expectations. The article also addresses operational steps for coordinating reporting across office and inpatient services.

Article Sections

1. Take care with PQRI when Medicare is secondary payer

   Discusses Medicare Physician Quality Reporting Initiative reporting when Medicare is the secondary payer, including payer workflow concerns and communication with non-Medicare plans.

2. Hospital discharge also an issue

   Addresses documentation and reporting challenges for hospital inpatient services and the need to coordinate quality information from the hospital setting.

3. Setting priorities is key

   Outlines a phased operational approach for practices preparing for PQRI reporting across different claim types during the implementation period.

4. Draft letter to primary payers when Medicare is secondary

   Provides a payer inquiry template focused on how claims with quality-reporting elements may be handled when a commercial plan is primary and Medicare is secondary.

5. Resources

   Lists supporting CMS and educational resources related to PQRI implementation.