PQRI reporting in 2010 - (Physician Quality Reporting Initiative )
The Centers for Medicare & Medicaid Services (CMS) has continued the Physician Quality Reporting Initiative (PQRI) into 2010 as required under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). PQRI is the first CMS-crafted national program to link the reporting of quality data to physician payment. The incentive payment for those eligible professionals who successfully participate in the program is 2 percent of the total allowed charges for Medicare Part B professional services covered under the physician fee schedule and furnished during the reporting period.
How does one use the measure specifications manual?
The first step for implementing PQRI in your office is to use the 2010 PQRI Measure Specifications Manual to identify measures applicable for professional services for which a physician’s practice routinely provides. The next step is to select those measures that make sense based upon prevalence and volume in the physician’s practice, as well as their individual or practice performance analysis and improvement priorities.
What is the description of the measure?
The measure specifications describe measure #20 as “Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic parenteral antibiotics, who have an order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours), prior the surgical incision (or start of procedure when no incision is required).” This narrative gives a high-level description of measure #20.
What are the instructions?
The instructions explain when the measure should be reported and who should report it. According to the instructions, measure #20 should be reported every time the procedure is performed on patients 18 years and older, with the indications for prophylactic parenteral antibiotics. The instructions further state that “Clinicians who perform the listed surgical procedures as specified in the denominator coding will submit this measure,” clearly indicating who should report the measure. In addition, the instructions indicate that there is no diagnosis associated with this measure.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Procedure code and description 95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory air...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...