decisionhealth Newsletters, Answer Books - 2009 Issue 7 (July)
Pay for Performance / Talk the talk Familiarize yourself with PQRI vocabulary
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Article Overview
This piece introduces the vocabulary used in Medicare’s Physician Quality Reporting Initiative (PQRI), with emphasis on how quality measures are structured and reported. It is aimed at clinicians, coders, and billing staff who need a plain-language overview of PQRI terminology, measure components, and the general role of CMS and related quality organizations.
Why This Topic Matters
Understanding PQRI terminology helps readers navigate quality reporting discussions and recognize the parts of a measure without getting lost in specialized jargon.
Article Sections
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Quality measures
Introduces the concept of quality measures and notes the kinds of organizations involved in developing them.
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Denominator
Explains the general role of denominator codes within a quality measure and how they relate to reportable circumstances.
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Numerator
Describes the general role of numerator reporting in PQRI and references the categories used for reporting measure-related care.
What You Will Learn
- The basic terms used in PQRI reporting
- How quality measures are organized into reporting components
- Which broad organizations are involved in measure development
- The general relationship between claim information and quality reporting
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Quality reporting staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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