ED Coding & Reimbursement Alert - 2007 Issue 18
SPECIAL PQRI CRASH COURSE: Alert--Your Physician May Be Meeting Quality Measures, But Not Documenting
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Article Overview
This article covers practical preparation for the Physician Quality Reporting Initiative (PQRI) in physician and hospital-based practices. It focuses on documentation workflows, encounter forms, reference sheets, hospital documentation capture, software configuration, and the use of PQRI-related modifiers and code resources. The piece is aimed at coders, billing staff, practice managers, and physicians who need to understand how quality measure reporting is being operationalized.
Why This Topic Matters
PQRI reporting depends on accurate capture of documented quality measures, so practices need systems that help clinicians record what they already do and help staff identify the supporting information. Understanding the workflow changes and reference resources discussed here can improve reporting readiness and reduce missed reporting opportunities.
Article Sections
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Preparing practices for PQRI participation
An overview of how different practices are adapting their workflows and documentation habits for PQRI reporting. The section introduces the operational changes discussed throughout the article.
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Encounter forms, reference sheets, and chart review
Examples of how staff are adding reporting prompts to forms and creating reference tools to help identify relevant diagnoses and measures. It also discusses ways coders review charts for documentation supporting quality reporting.
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Hospital documentation and software support
Discussion of obtaining documentation from hospital sources and using software tools or addenda to capture reporting information. The section also addresses coordination with vendors to ensure systems can accept PQRI-related entries.
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Modifiers and reporting exceptions
An explanation of the modifiers referenced in the article and the situations they are intended to address in PQRI reporting workflows. The section emphasizes the documentation challenges associated with capturing exceptions.
What You Will Learn
- How practices are organizing PQRI reporting workflows
- How encounter forms and reference sheets can support documentation capture
- How hospital-based documentation sources fit into reporting processes
- How software systems may need to be configured for reporting entries
- Which modifier-related issues arise when a measure is not performed
Who Should Read This
- Physicians
- Coders
- Billing staff
- Practice managers
- Compliance staff
- Quality reporting staff
Codes Discussed
Modifiers Discussed
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