QUALITY: Thousands Of Dollars Could Depend On A Few Extra 'G' Codes

Why This Topic Matters

Practice revenue may depend on whether the correct quality measures are reported consistently and whether the practice can document that the measures truly apply. The article helps readers understand the program framework so they can assess reporting readiness and administrative risk.

Article Sections

1. PQRI bonus overview and reporting expectations

   Introduces the CMS quality reporting program and summarizes the reporting threshold tied to bonus eligibility. It also outlines the general idea of measures that apply to a physician.

2. How CMS determines applicable measures

   Explains how applicability is assessed using code descriptors and clinical context. The section addresses how practices may determine whether a measure is relevant to a specific patient encounter.

3. Use of G codes and Category II codes

   Describes CMS guidance on reporting measures when more than one code type is available. It also notes CMS interest in shifting the program toward Category II codes over time.

4. Payment methodology and administrative issues

   Covers the broader payment structure for the incentive and the possibility of program changes in future years. It also discusses reporting at the group level versus the individual physician level.