decisionhealth Newsletters, Answer Books - 2009 Issue 7 (July)
Pay for Performance / PQRI primer What you need to know about Medicare's P4P program
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Article Overview
This article explains the basics of Medicare’s pay-for-performance approach, focused on the Physician Quality Reporting Initiative (PQRI). It covers how quality measures are reported, the role of claims- and registry-based reporting, and where physicians can find CMS measure specifications and related guidance. It is relevant for clinicians, coding staff, and practice managers who need a high-level understanding of quality reporting under Medicare.
Why This Topic Matters
The article helps readers understand a major shift in physician reimbursement tied to quality reporting. It is useful for practices that want to identify where quality measures intersect with claims coding and CMS reporting requirements.
What You Will Learn
- What Medicare’s pay-for-performance program is intended to do
- How quality measures are generally reported in a claims-based workflow
- Where CMS measure specifications and related resources are located
- Why individual measure specifications and measure group specifications must be distinguished
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Quality reporting staff
Codes Discussed
Modifiers Discussed
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