decisionhealth Newsletters, Part B News - 2009 Issue 2 (February)
Medicare secondary payer patients are eligible for PQRI
Subscribe or sign in to view the full article.
Article Overview
This article covers CMS guidance from a PQRI national provider call and related website information about patient eligibility for quality reporting when Medicare is primary or secondary payer. It is aimed at providers and coding/billing staff who report quality data through claims or registry workflows and need to understand how payer type, reporting method, and measure-group reporting affect participation. The article also mentions CMS updates under discussion for future group reporting options and points readers to CMS FAQ resources for more information.
Why This Topic Matters
PQRI reporting depends on correct patient inclusion, and payer status can affect whether quality data submitted on a claim will count. Understanding CMS’s guidance helps practices avoid excluding eligible patients or submitting data in a way that does not meet the chosen reporting method.
Article Sections
-
CMS guidance on PQRI patient eligibility
Introduces CMS discussion of which patients may be counted for quality reporting and why there has been confusion about eligibility.
-
Claims-based reporting and payer status
Describes how claims reporting relates to payer type and notes that patient inclusion depends on the reporting method and measure requirements.
-
Registry-based reporting and patient samples
Summarizes the registry reporting approach and how patient samples may differ from claims-based reporting.
-
Future group reporting and CMS resources
Mentions CMS plans for a group reporting option and directs readers to additional FAQ resources.
What You Will Learn
- How CMS addressed questions about patient eligibility for PQRI reporting
- How reporting method affects which patients may be included
- What CMS said about differences between claims-based and registry-based reporting
- Where CMS directs providers for additional PQRI guidance
- What future reporting changes CMS was discussing
Who Should Read This
- Physicians
- Practice managers
- Medical billers
- Medical coders
- Quality reporting staff
- Compliance staff
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com