ED Coding and Reimbursement Alert

Question: My ED doctors have put me in charge of setting up a Physician Quality Reporting Initiative (PQRI) program in an effort to collect the bonus from Medicare. Where should I start?


Indiana Subscriber

 
Answer: Anyone confused about PQRI--or with questions about setting up a PQRI program in the ED--should go immediately to the CMS PQRI tool kit.

Where? Check out the tool kit at www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp#TopOfPage.

-This kit includes valuable resources to assist eligible professionals in the successful integration of PQRI measurement into their practice. CMS suggests that eligible professionals review and discuss the following materials with their staff,- Medicare says.

The kit lists six PQRI -tools- designed to help practices comply with PQRI:

1. 2007 PQRI Physician Quality Measures--A numerical listing of all measures included in 2007 PQRI.

2. MLN Matters Article 5640: -Coding & Reporting Principles---A publication that introduces the coding and reporting principles underlying successful PQRI reporting.

3. 2007 PQRI Code Master--A numerical listing of all codes included in PQRI intended for incorporation into billing software.

4. 2007 Coding for Quality Handbook--This handbook delineates coding and reporting principles and provides implementation guidelines for how to successfully report measures using clinical scenarios.

5. 2007 Data Collection Worksheets--You should use measure-specific worksheets that walk the user step-by-step through reporting for each measure. -These worksheets may be used by the practice on a concurrent basis to collect PQRI data upon patient arrival for appointments,- CMS says.

6.  2007 PQRI Measure Finder Tool and User Guide--The Measure Finder Tool Version 1.1 helps ED physicians and coding staff to quickly search for applicable measures and their detailed specifications based on a single code or a combination of codes.

Heads up: CMS is using the Measure Finder Tool Version 1.1 as a replacement for the Measure Finder Tool Version 1.0. Version 1.1 addresses a technical problem in Version 1.0. Coders should delete the previous version of the Measure Finder Tool and download Measure Finder Tool Version 1.1, CMS says.