decisionhealth Newsletters, Part B News - 2009 Issue 3 (March)
Glitch causes carriers to reject 20 PQRI CPT II tracking codes
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Article Overview
This article explains a CMS-acknowledged issue affecting Physician Quality Reporting Initiative reporting at the start of the 2009 period, including which broad measure categories were involved and what providers should watch for on remittance advice. It is relevant to physicians, billing staff, and compliance teams working with PQRI submissions, carrier or MAC processing, and claim correction workflows.
Why This Topic Matters
The article helps readers understand a temporary reporting problem that could affect whether quality data submissions were accepted and how they were treated for incentive eligibility. It is useful for practices monitoring claim processing, remittance notices, and CMS reporting requirements.
Article Sections
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Reporting issue overview
Introduces a CMS-acknowledged problem affecting early 2009 PQRI reporting and describes the general type of submissions involved.
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Affected measure categories and quality data codes
Summarizes the measure areas and reporting categories referenced as part of the processing issue.
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How to verify acceptance on remittance advice
Explains the remittance advice indicator discussed in the article and the general method used to tell whether a submission was accepted.
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Resubmission and correction considerations
Describes the article’s guidance on claim corrections, timing, and the information needed to pursue a fix.
What You Will Learn
- What type of PQRI reporting problem CMS acknowledged
- Which broad measure groups were affected
- How providers could check remittance advice for processing status
- What general information is needed when seeking a claim correction
- What considerations the article raises about resubmission versus correction
Who Should Read This
- Physicians participating in PQRI
- Medical coders and coding auditors
- Billing and claims staff
- Practice managers
- Compliance and reimbursement teams
Codes Discussed
Code Ranges Discussed
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