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Thread: Pqri

  1. #1
    Join Date
    Apr 2007
    Terre Haute, IN

    Default Pqri

    AAPC: Back to School
    Help !!!!! I work for a small Billing company and some of the Providers are asking about PQRI. I have pulled up CMR information on the PQRI Measures Lists and the free workshop that is on AAPC. But i cant get my Mind wrapped around this.
    I'm the Only Coder here, and the billers dont have a clue.

    If anyone out there would be willing to take a little bit time out of the day to help
    me understand this so i can pass it along to the Billers.

    Thanks in advance !

  2. #2
    Join Date
    Apr 2007
    Daytona Beach, FL


    Unfortunately, PQRI does not take a little time to explain! Basically what you would need to do is go through the list of measures and pick at least three (I think) measures that you want to keep statistics on for CMS. There are hundreds of measures to choose from. Basically if you report these measures at least 80% of the time for your measure, you will receive a "bonus" payment of 2%. You would either have to do this for the entire year or for 6 months beginning with July 1. I understand that now it is voluntary to participate, however in the future it will be a requirement by Medicare and eventually you will be penalized 2% for not participating.

    The docs in one of our groups reports the measures for smoking, pnuemonia and flu shots. There are specific codes that need to be appended to the claim for that date of service. The codes must accompany the claim you submit for the patient services that specific date - you can't send a separate claim for the PQRI codes. The drs. documentation must reflect the information in the measure you are reporting - i.e. if the patient smokes or not must be documented in the chart. When we chose our measures, we looked at what our drs. normally did for each visit and what they normally documented so as not to cause them an further confusion. Each measure has the directions, the demographics of the patient's you would be keeping track of and the codes.

    This is a brief description of PQRI - hopefully it helps you a bit. CMS has a better description - although the reports are quite lenghty.

    Good Luck!
    Jodi Dibble, CPC

  3. #3
    Join Date
    Apr 2007

    Default There is an easier way...

    Not sure what type of providers you have but for my primary care providers we use the preventive measures group.



    I have a document, didn't pop up in the quick search I just did or I would have posted the link, that states you only need 15 patients for a full year and 8 for a half year now per provider. The patients no longer have to be consecutive they just have to be unique to the provider. This only applies to straight medicare (no HMOs).

    There is a really great support service for PQRI, they are very helpful if you need more info.


    There is also a registry based reporting option. I have CVT surgeons that we use that method because we are already reporting the same info for quality.

    Good luck,

    Laura, CPC, CPMA, CEMC

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