Optum360 coding books logo
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

View Article Archive

To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:

Medical Coding News Archives

CMS Makes PQRI Participation Easier

May 13, 2008:
The Centers for Medicare and Medicaid Services (CMS) has made revisions to the Physician Quality Reporting Initiative (PQRI) program that should make participating and meeting the reporting threshold easier for providers—which in turn should make your receiving the 1.5 percent incentive payment more likely.

Under the revisions, which were authorized by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSE), there are now two reporting periods and alternative criteria for reporting measures, as well as measure groups for reporting and expanded registry-based reporting methods.

The two reporting periods are the previously defined January 1 through December 31, 2008, and the newly defined July 1 through December 31, 2008. If the reporting criteria are met, the incentive payment will be based on Medicare allowed charges for the specific reporting period the provider has selected to use. For example, if the provider elects to report the six-month reporting period, the incentive payment will be based on the allowed Medicare charges for July1 through December 31.

Providers may now also report “measure groups.” CMS has created the following four groups:
  • Diabetes mellitus
  • End-stage renal disease
  • Chronic kidney disease
  • Preventive care
These groups contain at least four individual measures. Measure groups may be submitted using either the claims-based or registry-based method. Under the claims-based method, measure groups may be reported only for the six-month reporting period. Under the registry method, the 12-month reporting period may be used since this method allows retrospective review.

Providers may also meet the reporting threshold by using the alternative criteria, which involve the reporting of measure groups. A provider indicates the beginning of “consecutive patients” by reporting the appropriate HCPCS Level II G code on the fist claim. Under the registry reporting method, the provider may elect to use either the six- or 12-month reporting period. For the 12-month reporting period, the measure group must be selected for 30 consecutive patients; for six months, the measure group must be submitted for 15 consecutive patients.

For claims-based reporting, this alternative method applies only for the July 1 through December 31 reporting period. Consecutive patients are defined next in order. Patients are considered consecutive without regard to gender even though some measures in a group (preventive care measures) may apply only to male or female patients.

It is also important to remember that even though the year is almost half over, a provider may qualify for the January 1 through December 31 reporting period. Sixty of the 119 quality measures needed to be reported only once during the reporting period. For example, quality measure 1, hemoglobin A1c poor control in type 1 or 2 diabetes mellitus, requires that the appropriate quality code for the most recent hemoglobin A1c level be reported only once during the reporting period.

Deborah C. Hall
Clinical/Technical Editor


Sign in to
Your Account
Forgot your username?
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:

What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog