Outpatient Facility Coding Alert - 2007 Issue 10
Here Are the PQRI Ropes for EDs That Want to Participate
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Article Overview
This article explains how emergency departments could participate in Medicare’s Physician Quality Reporting Initiative (PQRI) by reporting qualifying quality measures on claims. It covers the claim-based reporting workflow, the role of Category II CPT codes and modifiers, the measure types relevant to emergency medicine and pneumonia care, and the general requirements tied to bonus eligibility. The piece is aimed at coders, billers, and emergency medicine practices trying to understand the reporting process and whether their claims support incentive participation.
Why This Topic Matters
PQRI reporting affects whether eligible practices can qualify for Medicare incentive payments, so understanding the claim-based process is important for compliance and revenue capture. The article helps readers identify which broad quality-reporting concepts apply to emergency department claims without needing to navigate the premium content first.
What You Will Learn
- How PQRI claim-based reporting works in an emergency department setting
- What kinds of quality measures are discussed for emergency medicine and pneumonia
- How modifiers are used in the context of quality reporting on claims
- What general eligibility concepts are associated with the Medicare bonus program
Who Should Read This
- Emergency department coders
- Medical billers
- Emergency medicine practice managers
- Quality reporting staff
- Physicians participating in Medicare reporting programs
Codes Discussed
Modifiers Discussed
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