PQRI: Test it before July start date, CMS urges

Why This Topic Matters

The piece helps readers assess whether they are ready to participate in a new Medicare quality reporting program and avoid avoidable reporting problems. It matters to practices that submit Medicare claims and need to align documentation, billing workflow, and reporting processes for quality measures.

Article Sections

1. CMS urges practices to test PQRI reporting before the July start date

   Introduces CMS guidance on preparing for the start of the PQRI bonus period. It discusses the need to test reporting workflows and review the upcoming quality measure specifications.

2. Measure selection and specification details

   Summarizes the types of measure information CMS said would be published for participating practices. It addresses measure lists, applicable patient attributes, and the general scope of the program.

3. Reporting workflow and claim submission guidance

   Explains the general operational steps CMS described for reporting quality measures. It covers claim submission timing, charge handling, and where the information is entered on paper and electronic claims.

4. Remittance, payment, and administrative follow-up

   Describes how practices could confirm that reporting was received and how results would be communicated. It also notes the article’s discussion of payment timing, dispute handling, and CMS review activities.

5. 4 steps to PQRI success

   Provides a short CMS-sourced overview of the reporting workflow at a high level. It focuses on identifying eligible encounters, documenting the measure, and submitting the reporting code on the claim.