ED Coding and Reimbursement Alert

Question: Our ED did not begin the Physician Quality Reporting Initiative (PQRI) earlier this year, but now we regret it. Will the PQRI program be a "one-shot deal," or will Medicare renew the program in the future?

Kentucky Subscriber

Answer: The PQRI program will likely be in place for many years to come and seems to be expanding. It takes a significant investment and internal building to successfully implement a PQRI program that ultimately leads to meeting the thresholds for payment, such as 80 percent reporting on three or more measures.

If the practice is interested in reporting in the future, now would be the time to start taking into consideration the following areas:

- the design of the patient encounter form

- physician education regarding the measures

- coder education and QA processes

- adding the codes to your billing system.

This program continues to evolve with changes to both the reporting periods and reporting mechanisms. Watch future issues of ED Coding Alert for more information.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.