PQRI Participation Puts More Plusses in Claims Column

Why This Topic Matters

PQRI affects whether eligible services can be reported toward Medicare incentive payment, so practices need a clear understanding of the program structure and reporting methods. The article is relevant to groups that code and submit physician claims, especially those working in emergency department settings or quality-reporting workflows.

Article Sections

1. What's In it for Me?

   Introduces the incentive nature of the program and why practices may be interested in participating. It frames the potential benefit of accurate reporting for eligible encounters.

2. What Extra Coding Work Is Involved?

   Explains the general reporting structure used for PQRI and how the program ties together different claim elements. It also introduces the concept of measure-based reporting and where supporting information is obtained.

3. Example

   Presents a sample emergency department scenario showing how a PQRI measure may be associated with a real encounter. The section illustrates the relationship between the encounter, the measure, and the reporting components.

4. What's New for 2010?

   Summarizes program updates for the reporting year, including frequency requirements and expanded submission options. It also notes the availability of non-claims reporting pathways.

5. I Want to Partake in PQRI: What Do I Do?

   Describes the overall implementation process for practices that want to participate in the program. It emphasizes measure selection, staff preparation, and ongoing capture of eligible encounters.

6. Of note

   Highlights a program change involving one measure being deleted and another being substituted. It also mentions the role of internal audit support in maintaining performance review.