decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 8 (August)
Ask Linda - PQRI: The scoop on bonus checks and hospital-based E/Ms
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Article Overview
This article discusses practical questions about the Physician Quality Reporting Initiative (PQRI), including how participation is tracked, how payments are handled at the physician and TIN level, and how hospital-based encounters may be included in measure specifications. It is aimed at coding and billing professionals who need a clearer understanding of PQRI reporting scope, CMS access, and the general structure of measure denominators and reporting periods.
Why This Topic Matters
PQRI reporting affects incentive payments and requires accurate understanding of which encounters count toward measure reporting. The article helps readers interpret CMS measure specifications and identify when hospital-based services may be relevant.
Article Sections
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Question
A reader asks about PQRI payment handling, physician-level reporting, and whether hospital services are included in reporting calculations.
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Answer
The response explains the general reporting and payment structure, CMS report access, and how hospital-based encounters may appear in measure specifications.
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PQRI in the hospital setting
This section discusses how measure specifications are used to determine whether hospital-based encounters are part of a measure's denominator.
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Official resources
The article provides CMS resource links for PQRI information, measure specifications, and secure access setup.
What You Will Learn
- How PQRI reporting is organized at a broad level
- How CMS reporting access and measure specifications support PQRI review
- How hospital-based encounters may relate to measure denominators
- How the article frames reporting across a yearly PQRI period
Who Should Read This
- Professional coders
- Billing staff
- Revenue cycle professionals
- Physician practices
- Hospital-based coding teams
Codes Discussed
Code Ranges Discussed
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