This document provides information about the 2007 Physician Quality Reporting Initiative (PQRI) including coding for quality measures. It discusses the PQRI tools available to help providers implement reporting like the measure list, coding handbook, and code master spreadsheet. It explains key principles for understanding the quality measures such as their scope, construct using codes to report clinical actions, and use of quality data codes and performance modifiers to relay reporting information. The document is intended to help providers successfully participate in the PQRI program.
The document provides an overview of the 2008 Physician Quality Reporting Initiative (PQRI) program run by the Centers for Medicare & Medicaid Services. It discusses that PQRI aims to shift Medicare payments to value-based purchasing by incentivizing reporting of quality measures. Eligible professionals can earn a 1.5% bonus payment by successfully reporting on PQRI measures. The document outlines 119 quality measures eligible for reporting, explains principles of the measures, and provides coding examples. It also discusses additional reporting options like registry-based and EHR-based reporting for PQRI in 2008.
The document discusses ensuring quality of health care data from a Canadian perspective. It provides an overview of the Canadian Institute for Health Information (CIHI), which collects health data from various partners across Canada. CIHI faces challenges as a secondary data collector, dealing with varying standards and incomplete data reporting. The document outlines CIHI's strategies to ensure data quality, including its data quality framework, quality reports and studies, and techniques for communicating data quality to different audiences.
Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
Accelerating Post-approval Change Management with ICH Q12Veeva Systems
Adopting ICH Q12 and modern technologies can reduce the number of changes that require regulatory approval as well as accelerate evaluation, implementation, and global approval of a change. In a 2017 PDA survey, almost 40% of respondents said that 50% or more of their post-approval changes required submission to a health authority. With increasing complexity in the manufacturing of new therapies and growing number of changes that require filing review and updates in multiple markets, the global post-approval change management (PACM) process is becoming unmanageable.
Modern technologies are reducing complexity in pharma by bringing together systems and people to seamlessly support global, end-to-end processes. With greater visibility and collaboration, change management processes are more efficient and less risky. In this webinar, learn:
What is ICH Q12 and potential benefits
Best practices and approaches to key PACM challenges
Approaches to manage ‘established conditions’
How technology can support ICH Q12 and simplify change management
Innovative ways leading pharma companies are addressing PACM
The document outlines 10 quality goals for managers including seeing possibilities in others, knowing company structure and policies, committing to team success and members, being human and approachable, staying versatile, thinking from employees' perspectives, having fun at work while staying focused, and being a role model through work ethics.
This document discusses key performance indicators (KPIs) for the head of quality position. It provides examples of KPIs, lists the steps to create KPIs for this role, discusses common mistakes in developing KPIs, and how to design effective KPIs. The document recommends visiting an external website for additional KPI samples and materials related to performance appraisal.
This document summarizes a study on the impact of quality reporting on consumer choice in healthcare. The study reviewed 24 articles on this topic. It found that 58% of studies showed quality reports significantly influence patient choice, while 26% found no significant impact. The magnitude of impact was between 10-20% of patients responding to quality reports. While quality reporting does seem to impact some consumers, it may not have fully solved the problem of information asymmetry.
The document provides an overview of the 2008 Physician Quality Reporting Initiative (PQRI) program run by the Centers for Medicare & Medicaid Services. It discusses that PQRI aims to shift Medicare payments to value-based purchasing by incentivizing reporting of quality measures. Eligible professionals can earn a 1.5% bonus payment by successfully reporting on PQRI measures. The document outlines 119 quality measures eligible for reporting, explains principles of the measures, and provides coding examples. It also discusses additional reporting options like registry-based and EHR-based reporting for PQRI in 2008.
The document discusses ensuring quality of health care data from a Canadian perspective. It provides an overview of the Canadian Institute for Health Information (CIHI), which collects health data from various partners across Canada. CIHI faces challenges as a secondary data collector, dealing with varying standards and incomplete data reporting. The document outlines CIHI's strategies to ensure data quality, including its data quality framework, quality reports and studies, and techniques for communicating data quality to different audiences.
Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
Accelerating Post-approval Change Management with ICH Q12Veeva Systems
Adopting ICH Q12 and modern technologies can reduce the number of changes that require regulatory approval as well as accelerate evaluation, implementation, and global approval of a change. In a 2017 PDA survey, almost 40% of respondents said that 50% or more of their post-approval changes required submission to a health authority. With increasing complexity in the manufacturing of new therapies and growing number of changes that require filing review and updates in multiple markets, the global post-approval change management (PACM) process is becoming unmanageable.
Modern technologies are reducing complexity in pharma by bringing together systems and people to seamlessly support global, end-to-end processes. With greater visibility and collaboration, change management processes are more efficient and less risky. In this webinar, learn:
What is ICH Q12 and potential benefits
Best practices and approaches to key PACM challenges
Approaches to manage ‘established conditions’
How technology can support ICH Q12 and simplify change management
Innovative ways leading pharma companies are addressing PACM
The document outlines 10 quality goals for managers including seeing possibilities in others, knowing company structure and policies, committing to team success and members, being human and approachable, staying versatile, thinking from employees' perspectives, having fun at work while staying focused, and being a role model through work ethics.
This document discusses key performance indicators (KPIs) for the head of quality position. It provides examples of KPIs, lists the steps to create KPIs for this role, discusses common mistakes in developing KPIs, and how to design effective KPIs. The document recommends visiting an external website for additional KPI samples and materials related to performance appraisal.
This document summarizes a study on the impact of quality reporting on consumer choice in healthcare. The study reviewed 24 articles on this topic. It found that 58% of studies showed quality reports significantly influence patient choice, while 26% found no significant impact. The magnitude of impact was between 10-20% of patients responding to quality reports. While quality reporting does seem to impact some consumers, it may not have fully solved the problem of information asymmetry.
This document discusses quality key performance indicator (KPI) examples and how to design effective KPIs. It provides examples of different types of KPIs such as process, input, output, leading, and lagging KPIs. The document also outlines steps for creating KPIs, including defining objectives, identifying key result areas and tasks, and determining methods to measure results. Common mistakes in developing KPIs, such as having too many metrics or ones that do not change over time, are also examined.
Top 12 Skills for a Successful Career in the Public SectorOxbridge Academy
Want to carve out a career in the public sector? Watch this presentation to see just what skills you'll need to get ahead.
Oxbridge Academy has a range of Public Sector Management and Finances courses that will teach you some of the top skills you'll need to succeed.
This document outlines key performance indicators (KPIs) for evaluating a software quality team. It describes 5 KPIs related to: 1) implementing acceptance criteria, 2) on-time delivery with quality, 3) test case traceability and coverage, 4) test case effectiveness, and 5) defect removal efficiency. For each KPI, it provides examples of how to calculate the metric score and map it to a performance level. It also defines what constitutes a "critical defect" and provides an example of how a test manager's KPI would be calculated based on the individual scores of testers on a project.
The document discusses key performance indicators (KPIs) and provides examples of KPIs across different areas of a business. It defines KPIs and explains their purpose is to measure performance against objectives. KPIs can be input, process, output, or outcome measures and should be meaningful, measurable, quantitative or qualitative, routinely collected, comparable, and useful. The document provides examples of KPIs for areas like return/profit, productivity, employee development, quality assurance, research and development, organizational image, and legislative relations.
Performance metrics are an essential element of the management review process.
Quality metrics may include elements such as customer satisfaction, supplier performance, manufacturing defects, complaints, cycle times and many other internal or external processes.
This presentation provides a framework for establishing right quality indicators for evaluating the performance of the quality system.
The document provides guidance on principles of high quality assessment, including establishing clear learning targets in different domains like cognitive, psychomotor, and affective. It emphasizes the importance of students understanding evaluation criteria and receiving regular feedback. Effective assessments also arise from clear achievement targets and reflect what students will know and be able to do.
This document discusses key performance indicators (KPIs) for a quality control (QC) manager position. It provides examples of KPIs, steps for creating a KPI system, common mistakes to avoid, and how to design effective KPIs. The document recommends visiting an external website for additional KPI samples and materials related to performance appraisal forms, methods, and review phrases.
10 principles for designing quality control scorecard and KPIsAleksey Savkin
A Balanced Scorecard is not positioned as a quality control tool, but regularly I see among our users efforts to integrate quality-related metrics into their Balanced Scorecards, or simply create a KPI scorecards with a bulk of different quality indicators. I've compiled the list of 10 best practices that we've learned from these cases.
As always, I'd like to hear your opinion. Do you use quality indicators on your business scorecard?
Based on: http://www.bscdesigner.com/10-tips-about-using-business-scorecard-and-kpis-for-ongoing-quality-control.htm
The document discusses establishing metrics and key performance indicators (KPIs) for quality management. It outlines a formula called SUCCESSFUL which involves setting business goals, understanding department impacts, choosing business processes, creating process goals, examining metrics, standardizing measurements, integrating data sources, and establishing indicators and thresholds. Useful metrics discussed include defect removal efficiency, test case effectiveness, traceability, code coverage, and defects by severity, status, and root cause. Baselines are suggested for starting metrics tracking.
This document discusses formative assessment and providing effective feedback to students. It emphasizes the importance of having clear learning targets, assessing students in a variety of ways, and giving descriptive feedback to help students improve. Some key points covered include setting clear goals for students, communicating expectations, involving students in self-assessment, and using feedback to guide further learning.
Presentation by David Farber, FDA Life Science Partner at King & Spalding, about US Reimbursement.
I. Introduction
• II. FDA Approval vs. Reimbursement
• a. Different Standards
b. Clinical Evidence Needed
• III. The Three Keys to Reimbursement
A. Coverage
B. Coding
C. Payment
• IV. What’s New for 2019
• V. Reimbursement for MedTech AI Solutions
• VI. Tips for Successful Reimbursement
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Here are three scenarios that could result in overpayments subject to
limitation on recoupment under Section 935:
1. A hospital is paid for an inpatient admission under Medicare Part A. Upon a post-
payment review, the MAC determines the admission was not medically necessary
and issues a written demand letter for repayment of the claim. This would be
subject to 935 limitations.
2. A home health agency receives a Request for Anticipated Payment (RAP) and
provides services to a Medicare beneficiary. Upon filing the final claim, the MAC
determines the beneficiary was not homebound and denies the claim. A written
demand is issued.
The document discusses clinical quality measures (CQMs) and reporting CQMs through Practice Fusion to meet requirements for programs like Meaningful Use and PQRS. It explains that providers are increasingly evaluated on quality and outcomes, describes key quality programs and their CQM reporting requirements, and provides guidance on selecting applicable CQMs and the reporting process through Practice Fusion.
Clinical data management (CDM) ensures the collection, integration, and availability of high-quality data from clinical trials. It supports clinical research and analysis across different study types. CDM tools like CDMS help manage large amounts of multicenter trial data. Regulations like 21 CFR Part 11 require electronic records and validated systems to ensure accurate, reliable data. Guidelines from SCDM and CDISC provide standards for good CDM practices and data collection. CDM processes clinical research data from source documents through database entry, quality checking, analysis, and archiving to support regulatory approval and conclusions about clinical results.
This presentation was shared with an audience at the AHLA Fundamentals of Health Law program in November 2008.
It contains some basic coding and compliance information to introduce health lawyers to the coding world including recent hot topics under scrutiny.
The document provides guidance on the 2007 Physician Quality Reporting Initiative (PQRI) for eligible medical professionals. It describes the goals of the PQRI to focus on quality of care and reward reporting of quality measures with financial incentives. It outlines the eligible professionals, quality measures, reporting requirements, and bonus payments for successful reporting. It also provides details on understanding the quality measures, applicable codes, modifiers, and examples of successful reporting.
Tactical Management Inc. (TMI) provides data management solutions to healthcare organizations like physician practices and Medicare Advantage plans. They help clients improve accuracy, insight, and impact through informatics services, medical record retrieval, and technology solutions. TMI also offers education services to help providers document diagnoses more completely to ensure accurate risk adjustment scores and reimbursement levels.
Presentation for mHealth Israel by David Farber, Partner, King & Spalding, about US Reimbursement. The path from approval to market and navigating the world of reimbursement. The lecture introduces the basics of Medicare reimbursement, explores strategies to maximize reimbursement in certain key areas, distinguishes the differences between CMS’s mission and FDA’s mission, and emphasizes steps in an early reimbursement strategy for successful product development.
The document discusses Michigan's Primary Care Transformation Demonstration Project. It provides information about 6 month and 12 month incentive disbursements, care manager utilization and patient registry status, HEDIS measure attainment, and care manager activity reporting requirements. It also discusses care manager disciplines, activity data collection, reporting options, and required data fields. Additional topics include learning activity requirements, education programs, webinars, Medicare Advantage quality measures and bonuses, risk adjustment importance, and new Medicare preventive services.
Medical coding is the process of transforming transcribed data into set of numerical codes using a system of numbers to represent various medical problems, (diagnoses), and treatments (procedures
This document discusses quality key performance indicator (KPI) examples and how to design effective KPIs. It provides examples of different types of KPIs such as process, input, output, leading, and lagging KPIs. The document also outlines steps for creating KPIs, including defining objectives, identifying key result areas and tasks, and determining methods to measure results. Common mistakes in developing KPIs, such as having too many metrics or ones that do not change over time, are also examined.
Top 12 Skills for a Successful Career in the Public SectorOxbridge Academy
Want to carve out a career in the public sector? Watch this presentation to see just what skills you'll need to get ahead.
Oxbridge Academy has a range of Public Sector Management and Finances courses that will teach you some of the top skills you'll need to succeed.
This document outlines key performance indicators (KPIs) for evaluating a software quality team. It describes 5 KPIs related to: 1) implementing acceptance criteria, 2) on-time delivery with quality, 3) test case traceability and coverage, 4) test case effectiveness, and 5) defect removal efficiency. For each KPI, it provides examples of how to calculate the metric score and map it to a performance level. It also defines what constitutes a "critical defect" and provides an example of how a test manager's KPI would be calculated based on the individual scores of testers on a project.
The document discusses key performance indicators (KPIs) and provides examples of KPIs across different areas of a business. It defines KPIs and explains their purpose is to measure performance against objectives. KPIs can be input, process, output, or outcome measures and should be meaningful, measurable, quantitative or qualitative, routinely collected, comparable, and useful. The document provides examples of KPIs for areas like return/profit, productivity, employee development, quality assurance, research and development, organizational image, and legislative relations.
Performance metrics are an essential element of the management review process.
Quality metrics may include elements such as customer satisfaction, supplier performance, manufacturing defects, complaints, cycle times and many other internal or external processes.
This presentation provides a framework for establishing right quality indicators for evaluating the performance of the quality system.
The document provides guidance on principles of high quality assessment, including establishing clear learning targets in different domains like cognitive, psychomotor, and affective. It emphasizes the importance of students understanding evaluation criteria and receiving regular feedback. Effective assessments also arise from clear achievement targets and reflect what students will know and be able to do.
This document discusses key performance indicators (KPIs) for a quality control (QC) manager position. It provides examples of KPIs, steps for creating a KPI system, common mistakes to avoid, and how to design effective KPIs. The document recommends visiting an external website for additional KPI samples and materials related to performance appraisal forms, methods, and review phrases.
10 principles for designing quality control scorecard and KPIsAleksey Savkin
A Balanced Scorecard is not positioned as a quality control tool, but regularly I see among our users efforts to integrate quality-related metrics into their Balanced Scorecards, or simply create a KPI scorecards with a bulk of different quality indicators. I've compiled the list of 10 best practices that we've learned from these cases.
As always, I'd like to hear your opinion. Do you use quality indicators on your business scorecard?
Based on: http://www.bscdesigner.com/10-tips-about-using-business-scorecard-and-kpis-for-ongoing-quality-control.htm
The document discusses establishing metrics and key performance indicators (KPIs) for quality management. It outlines a formula called SUCCESSFUL which involves setting business goals, understanding department impacts, choosing business processes, creating process goals, examining metrics, standardizing measurements, integrating data sources, and establishing indicators and thresholds. Useful metrics discussed include defect removal efficiency, test case effectiveness, traceability, code coverage, and defects by severity, status, and root cause. Baselines are suggested for starting metrics tracking.
This document discusses formative assessment and providing effective feedback to students. It emphasizes the importance of having clear learning targets, assessing students in a variety of ways, and giving descriptive feedback to help students improve. Some key points covered include setting clear goals for students, communicating expectations, involving students in self-assessment, and using feedback to guide further learning.
Presentation by David Farber, FDA Life Science Partner at King & Spalding, about US Reimbursement.
I. Introduction
• II. FDA Approval vs. Reimbursement
• a. Different Standards
b. Clinical Evidence Needed
• III. The Three Keys to Reimbursement
A. Coverage
B. Coding
C. Payment
• IV. What’s New for 2019
• V. Reimbursement for MedTech AI Solutions
• VI. Tips for Successful Reimbursement
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Here are three scenarios that could result in overpayments subject to
limitation on recoupment under Section 935:
1. A hospital is paid for an inpatient admission under Medicare Part A. Upon a post-
payment review, the MAC determines the admission was not medically necessary
and issues a written demand letter for repayment of the claim. This would be
subject to 935 limitations.
2. A home health agency receives a Request for Anticipated Payment (RAP) and
provides services to a Medicare beneficiary. Upon filing the final claim, the MAC
determines the beneficiary was not homebound and denies the claim. A written
demand is issued.
The document discusses clinical quality measures (CQMs) and reporting CQMs through Practice Fusion to meet requirements for programs like Meaningful Use and PQRS. It explains that providers are increasingly evaluated on quality and outcomes, describes key quality programs and their CQM reporting requirements, and provides guidance on selecting applicable CQMs and the reporting process through Practice Fusion.
Clinical data management (CDM) ensures the collection, integration, and availability of high-quality data from clinical trials. It supports clinical research and analysis across different study types. CDM tools like CDMS help manage large amounts of multicenter trial data. Regulations like 21 CFR Part 11 require electronic records and validated systems to ensure accurate, reliable data. Guidelines from SCDM and CDISC provide standards for good CDM practices and data collection. CDM processes clinical research data from source documents through database entry, quality checking, analysis, and archiving to support regulatory approval and conclusions about clinical results.
This presentation was shared with an audience at the AHLA Fundamentals of Health Law program in November 2008.
It contains some basic coding and compliance information to introduce health lawyers to the coding world including recent hot topics under scrutiny.
The document provides guidance on the 2007 Physician Quality Reporting Initiative (PQRI) for eligible medical professionals. It describes the goals of the PQRI to focus on quality of care and reward reporting of quality measures with financial incentives. It outlines the eligible professionals, quality measures, reporting requirements, and bonus payments for successful reporting. It also provides details on understanding the quality measures, applicable codes, modifiers, and examples of successful reporting.
Tactical Management Inc. (TMI) provides data management solutions to healthcare organizations like physician practices and Medicare Advantage plans. They help clients improve accuracy, insight, and impact through informatics services, medical record retrieval, and technology solutions. TMI also offers education services to help providers document diagnoses more completely to ensure accurate risk adjustment scores and reimbursement levels.
Presentation for mHealth Israel by David Farber, Partner, King & Spalding, about US Reimbursement. The path from approval to market and navigating the world of reimbursement. The lecture introduces the basics of Medicare reimbursement, explores strategies to maximize reimbursement in certain key areas, distinguishes the differences between CMS’s mission and FDA’s mission, and emphasizes steps in an early reimbursement strategy for successful product development.
The document discusses Michigan's Primary Care Transformation Demonstration Project. It provides information about 6 month and 12 month incentive disbursements, care manager utilization and patient registry status, HEDIS measure attainment, and care manager activity reporting requirements. It also discusses care manager disciplines, activity data collection, reporting options, and required data fields. Additional topics include learning activity requirements, education programs, webinars, Medicare Advantage quality measures and bonuses, risk adjustment importance, and new Medicare preventive services.
Medical coding is the process of transforming transcribed data into set of numerical codes using a system of numbers to represent various medical problems, (diagnoses), and treatments (procedures
The document discusses strategies for ensuring quality of health care data in Canada. It provides an overview of the Canadian Institute for Health Information (CIHI), which collects health data from various partners across Canada. Data quality challenges include CIHI being a secondary data collector and variability among data providers. CIHI addresses this through a data quality framework involving assessment, implementation, and documentation. It also produces data quality reports and studies to evaluate accuracy, comparability, and other metrics. The goal is to improve health policy, management, and public awareness through high quality data.
This document discusses accountable care organizations (ACOs) under the Medicare Shared Savings Program and the role of health information technology. It provides an overview of ACO definitions, program requirements, governance structures, beneficiary assignment, risk models, and estimated participation levels and costs/savings. It also outlines the types of data that need to be shared between CMS, ACOs, and within ACOs themselves. This includes claims data, electronic medical record data, quality reporting measures, and data to support care coordination, clinical decision-making, and active care management. Analytics are seen as key to generating actionable insights from these diverse data sources to improve processes, outcomes, provider performance and care delivery.
This document provides information about coding tips for orthopaedic offices. It discusses reimbursement statistics for different orthopaedic procedures, insurance issues to consider, guidelines for evaluation and management visits and other orthopaedic procedures. It also reviews modifiers like 24, 25, and 57 which are important for orthopaedic coding. The presenter has many years of experience in orthopaedic coding and compliance.
Complete and accurate clinical documentation in the medical record has a direct impact on the assignment of codes, more accurate levels of reimbursement, and is critical to the higher quality of patient care. This paper describes the development of a system which can automatically flag the cases if there is an opportunity of improvement in patient clinical doc- uments. Automated Clinical Documentation Improvement (CDI) leverages the natural language processing (NLP) and contextual understanding of health record structure with additional business rules logic, helping CDI specialists identify critical documentation information that may be missing from the medical record. This results in more specific coding opportunity and better under- standing of the clinical complexity for accurate reimbursement. This system helped increase CDI specialists’ productivity by efficiently filtering cases which need more attention from them.
US Healthcare Reimbursement for MedTech & Digital HealthLevi Shapiro
Overview of the US healthcare reimbursement framework as it relates to MedTech and Digital Health companies by David Farber, Senior Partner, King & Spalding law firm. Includes Introduction FDA Approval vs. Reimbursement; Different Standards; Clinical Evidence Needed; The Three Keys to Reimbursement Coverage; Coding; Payment; What’s New for 2019 Reimbursement for MedTech; AI Solutions Tips for Successful Reimbursement
5 Reasons Why Coding and Documentation Audits are More Important than EverezDI
Auditing and documentation are important for healthcare organizations to ensure accurate billing and reimbursement. The document discusses 5 reasons why audits are more important than ever: 1) They enhance data quality which leads to better reporting and research opportunities. 2) They increase operational efficiency by automating manual tasks and detecting errors. 3) They improve patient safety by finding errors and giving real-time feedback. 4) They improve relations between healthcare providers and HIM staff by providing feedback. 5) They enhance reimbursement accuracy by ensuring proper documentation of patient complications. The document also discusses how one hospital improved coding efficiency, decreased discharge times, and saved $1 million by implementing an AI-powered auditing solution.
The alphabet soup of clinical quality measures reporting and reimbursement 2...Bill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
• How the Eligible Hospital and Eligible Professional reimbursement models will change in 2017 and going forward.
• Compare and contrast the requirements for quality measure reporting and identify strategies to ensure compliance.
• The potential impact to hospital reimbursement of current and proposed programs that will affect quality reporting for hospitals and providers.
• How to improve efficiency and quality by aligning measures across initiatives.
• Where to find current information (and breaking news) on each of these Quality Initiatives.
In the past, organizations participating in quality reporting initiatives involved abstractors sifting through a small sample set of unstructured data in paper charts to then manually convert their findings to discrete reportable data. This approach is time consuming and requires extensive amount of resources from both IT and Quality staff. Aligning quality initiatives can improve efficiencies and processes, and contribute to population health management efforts, both locally and nationally.
At the conclusion of this presentation, attendees will be able to apply what they’ve learned about aligning Clinical Quality Measures across initiatives specific to their organization to improve reimbursements, reduce their reporting burden, increase efficiencies, and realize the benefits of Population Health Management.
If you are responsible for hospital quality, IT, clinical quality measure initiatives or have a vested interest in making sure your organization is aligning quality measures reporting, this informational session is a must.
The document discusses iRVU, a mobile app that allows physicians to track their Relative Value Units (RVUs). RVUs are assigned by Medicare to compare the value of medical services, and most physicians are paid based on RVUs. The iRVU app lets users log the number of services provided and view stats on total RVUs, charges, and RVUs per encounter. It helps physicians estimate their RVU-based pay and compare their performance to colleagues or benchmarks. The app is free and available on iPhone, iPad and Android devices.
Medical Templates Making Medical Documentation Simple And Painlesse-MedTools
Making medical documentation simple and painless with template based documentation tools. Prompters help remind users about the 1997 E&M Documentation guidelines, to help insure compliance with the requirements for the highest levels of medical billing.
Money Your Practice May Be Throwing Awaye-MedTools
The document discusses ways physicians can improve documentation and coding to maximize reimbursement from insurance companies. It notes that many physicians under-code patient encounters, potentially losing $300 or more per day. Implementing electronic medical records or using standardized paper forms can help improve documentation and billing accuracy to recoup this lost revenue without requiring additional work. The document estimates that decreasing billing errors by 50% through better documentation could increase practice revenues by around $40,000 per year.
This document provides strategies for physicians to successfully participate in the 2007 Physician Quality Reporting Initiative (PQRI) program, which provides bonus payments for reporting on quality of care measures. It discusses selecting quality measures, defining team roles, modifying workflows to capture quality data, reporting the data using claims codes, and understanding how satisfactory reporting and bonus payments will be determined. The goal is to help integrate quality data reporting into clinical practices to improve care and prepare for future pay-for-performance programs.
The document provides information about the 2007 Physician Quality Reporting Initiative (PQRI) including eligible professionals, quality measures, reporting requirements, bonus payments, validation, and considerations for 2008. Eligible professionals can earn a 1.5% bonus payment by reporting certain quality measures to the Centers for Medicare and Medicaid Services between July and December 2007.
MedicalTemplates are physician-designed templates for documenting patient encounters that are suitable for primary care providers, specialists, and hospital settings. The templates are based on 1997 HCFA Evaluation and Management Documentation Guidelines and include quality measures for the Medicare 2007 PQRI program. Templates can be customized and are available for a variety of clinical scenarios, including hospital admissions, follow-up visits, and evaluations for specific conditions like asthma, COPD, and lung diseases. Using the templates can help improve documentation, coding, billing, and performance in pay-for-quality programs while decreasing audit risk.
Cosa hanno in comune un mattoncino Lego e la backdoor XZ?Speck&Tech
ABSTRACT: A prima vista, un mattoncino Lego e la backdoor XZ potrebbero avere in comune il fatto di essere entrambi blocchi di costruzione, o dipendenze di progetti creativi e software. La realtà è che un mattoncino Lego e il caso della backdoor XZ hanno molto di più di tutto ciò in comune.
Partecipate alla presentazione per immergervi in una storia di interoperabilità, standard e formati aperti, per poi discutere del ruolo importante che i contributori hanno in una comunità open source sostenibile.
BIO: Sostenitrice del software libero e dei formati standard e aperti. È stata un membro attivo dei progetti Fedora e openSUSE e ha co-fondato l'Associazione LibreItalia dove è stata coinvolta in diversi eventi, migrazioni e formazione relativi a LibreOffice. In precedenza ha lavorato a migrazioni e corsi di formazione su LibreOffice per diverse amministrazioni pubbliche e privati. Da gennaio 2020 lavora in SUSE come Software Release Engineer per Uyuni e SUSE Manager e quando non segue la sua passione per i computer e per Geeko coltiva la sua curiosità per l'astronomia (da cui deriva il suo nickname deneb_alpha).
AI 101: An Introduction to the Basics and Impact of Artificial IntelligenceIndexBug
Imagine a world where machines not only perform tasks but also learn, adapt, and make decisions. This is the promise of Artificial Intelligence (AI), a technology that's not just enhancing our lives but revolutionizing entire industries.
“An Outlook of the Ongoing and Future Relationship between Blockchain Technologies and Process-aware Information Systems.” Invited talk at the joint workshop on Blockchain for Information Systems (BC4IS) and Blockchain for Trusted Data Sharing (B4TDS), co-located with with the 36th International Conference on Advanced Information Systems Engineering (CAiSE), 3 June 2024, Limassol, Cyprus.
Have you ever been confused by the myriad of choices offered by AWS for hosting a website or an API?
Lambda, Elastic Beanstalk, Lightsail, Amplify, S3 (and more!) can each host websites + APIs. But which one should we choose?
Which one is cheapest? Which one is fastest? Which one will scale to meet our needs?
Join me in this session as we dive into each AWS hosting service to determine which one is best for your scenario and explain why!
For the full video of this presentation, please visit: https://www.edge-ai-vision.com/2024/06/building-and-scaling-ai-applications-with-the-nx-ai-manager-a-presentation-from-network-optix/
Robin van Emden, Senior Director of Data Science at Network Optix, presents the “Building and Scaling AI Applications with the Nx AI Manager,” tutorial at the May 2024 Embedded Vision Summit.
In this presentation, van Emden covers the basics of scaling edge AI solutions using the Nx tool kit. He emphasizes the process of developing AI models and deploying them globally. He also showcases the conversion of AI models and the creation of effective edge AI pipelines, with a focus on pre-processing, model conversion, selecting the appropriate inference engine for the target hardware and post-processing.
van Emden shows how Nx can simplify the developer’s life and facilitate a rapid transition from concept to production-ready applications.He provides valuable insights into developing scalable and efficient edge AI solutions, with a strong focus on practical implementation.
Threats to mobile devices are more prevalent and increasing in scope and complexity. Users of mobile devices desire to take full advantage of the features
available on those devices, but many of the features provide convenience and capability but sacrifice security. This best practices guide outlines steps the users can take to better protect personal devices and information.
Let's Integrate MuleSoft RPA, COMPOSER, APM with AWS IDP along with Slackshyamraj55
Discover the seamless integration of RPA (Robotic Process Automation), COMPOSER, and APM with AWS IDP enhanced with Slack notifications. Explore how these technologies converge to streamline workflows, optimize performance, and ensure secure access, all while leveraging the power of AWS IDP and real-time communication via Slack notifications.
Monitoring and Managing Anomaly Detection on OpenShift.pdfTosin Akinosho
Monitoring and Managing Anomaly Detection on OpenShift
Overview
Dive into the world of anomaly detection on edge devices with our comprehensive hands-on tutorial. This SlideShare presentation will guide you through the entire process, from data collection and model training to edge deployment and real-time monitoring. Perfect for those looking to implement robust anomaly detection systems on resource-constrained IoT/edge devices.
Key Topics Covered
1. Introduction to Anomaly Detection
- Understand the fundamentals of anomaly detection and its importance in identifying unusual behavior or failures in systems.
2. Understanding Edge (IoT)
- Learn about edge computing and IoT, and how they enable real-time data processing and decision-making at the source.
3. What is ArgoCD?
- Discover ArgoCD, a declarative, GitOps continuous delivery tool for Kubernetes, and its role in deploying applications on edge devices.
4. Deployment Using ArgoCD for Edge Devices
- Step-by-step guide on deploying anomaly detection models on edge devices using ArgoCD.
5. Introduction to Apache Kafka and S3
- Explore Apache Kafka for real-time data streaming and Amazon S3 for scalable storage solutions.
6. Viewing Kafka Messages in the Data Lake
- Learn how to view and analyze Kafka messages stored in a data lake for better insights.
7. What is Prometheus?
- Get to know Prometheus, an open-source monitoring and alerting toolkit, and its application in monitoring edge devices.
8. Monitoring Application Metrics with Prometheus
- Detailed instructions on setting up Prometheus to monitor the performance and health of your anomaly detection system.
9. What is Camel K?
- Introduction to Camel K, a lightweight integration framework built on Apache Camel, designed for Kubernetes.
10. Configuring Camel K Integrations for Data Pipelines
- Learn how to configure Camel K for seamless data pipeline integrations in your anomaly detection workflow.
11. What is a Jupyter Notebook?
- Overview of Jupyter Notebooks, an open-source web application for creating and sharing documents with live code, equations, visualizations, and narrative text.
12. Jupyter Notebooks with Code Examples
- Hands-on examples and code snippets in Jupyter Notebooks to help you implement and test anomaly detection models.
In the rapidly evolving landscape of technologies, XML continues to play a vital role in structuring, storing, and transporting data across diverse systems. The recent advancements in artificial intelligence (AI) present new methodologies for enhancing XML development workflows, introducing efficiency, automation, and intelligent capabilities. This presentation will outline the scope and perspective of utilizing AI in XML development. The potential benefits and the possible pitfalls will be highlighted, providing a balanced view of the subject.
We will explore the capabilities of AI in understanding XML markup languages and autonomously creating structured XML content. Additionally, we will examine the capacity of AI to enrich plain text with appropriate XML markup. Practical examples and methodological guidelines will be provided to elucidate how AI can be effectively prompted to interpret and generate accurate XML markup.
Further emphasis will be placed on the role of AI in developing XSLT, or schemas such as XSD and Schematron. We will address the techniques and strategies adopted to create prompts for generating code, explaining code, or refactoring the code, and the results achieved.
The discussion will extend to how AI can be used to transform XML content. In particular, the focus will be on the use of AI XPath extension functions in XSLT, Schematron, Schematron Quick Fixes, or for XML content refactoring.
The presentation aims to deliver a comprehensive overview of AI usage in XML development, providing attendees with the necessary knowledge to make informed decisions. Whether you’re at the early stages of adopting AI or considering integrating it in advanced XML development, this presentation will cover all levels of expertise.
By highlighting the potential advantages and challenges of integrating AI with XML development tools and languages, the presentation seeks to inspire thoughtful conversation around the future of XML development. We’ll not only delve into the technical aspects of AI-powered XML development but also discuss practical implications and possible future directions.
In his public lecture, Christian Timmerer provides insights into the fascinating history of video streaming, starting from its humble beginnings before YouTube to the groundbreaking technologies that now dominate platforms like Netflix and ORF ON. Timmerer also presents provocative contributions of his own that have significantly influenced the industry. He concludes by looking at future challenges and invites the audience to join in a discussion.
HCL Notes and Domino License Cost Reduction in the World of DLAUpanagenda
Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-and-domino-license-cost-reduction-in-the-world-of-dlau/
The introduction of DLAU and the CCB & CCX licensing model caused quite a stir in the HCL community. As a Notes and Domino customer, you may have faced challenges with unexpected user counts and license costs. You probably have questions on how this new licensing approach works and how to benefit from it. Most importantly, you likely have budget constraints and want to save money where possible. Don’t worry, we can help with all of this!
We’ll show you how to fix common misconfigurations that cause higher-than-expected user counts, and how to identify accounts which you can deactivate to save money. There are also frequent patterns that can cause unnecessary cost, like using a person document instead of a mail-in for shared mailboxes. We’ll provide examples and solutions for those as well. And naturally we’ll explain the new licensing model.
Join HCL Ambassador Marc Thomas in this webinar with a special guest appearance from Franz Walder. It will give you the tools and know-how to stay on top of what is going on with Domino licensing. You will be able lower your cost through an optimized configuration and keep it low going forward.
These topics will be covered
- Reducing license cost by finding and fixing misconfigurations and superfluous accounts
- How do CCB and CCX licenses really work?
- Understanding the DLAU tool and how to best utilize it
- Tips for common problem areas, like team mailboxes, functional/test users, etc
- Practical examples and best practices to implement right away
Essentials of Automations: The Art of Triggers and Actions in FMESafe Software
In this second installment of our Essentials of Automations webinar series, we’ll explore the landscape of triggers and actions, guiding you through the nuances of authoring and adapting workspaces for seamless automations. Gain an understanding of the full spectrum of triggers and actions available in FME, empowering you to enhance your workspaces for efficient automation.
We’ll kick things off by showcasing the most commonly used event-based triggers, introducing you to various automation workflows like manual triggers, schedules, directory watchers, and more. Plus, see how these elements play out in real scenarios.
Whether you’re tweaking your current setup or building from the ground up, this session will arm you with the tools and insights needed to transform your FME usage into a powerhouse of productivity. Join us to discover effective strategies that simplify complex processes, enhancing your productivity and transforming your data management practices with FME. Let’s turn complexity into clarity and make your workspaces work wonders!
Generating privacy-protected synthetic data using Secludy and MilvusZilliz
During this demo, the founders of Secludy will demonstrate how their system utilizes Milvus to store and manipulate embeddings for generating privacy-protected synthetic data. Their approach not only maintains the confidentiality of the original data but also enhances the utility and scalability of LLMs under privacy constraints. Attendees, including machine learning engineers, data scientists, and data managers, will witness first-hand how Secludy's integration with Milvus empowers organizations to harness the power of LLMs securely and efficiently.
UiPath Test Automation using UiPath Test Suite series, part 6DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 6. In this session, we will cover Test Automation with generative AI and Open AI.
UiPath Test Automation with generative AI and Open AI webinar offers an in-depth exploration of leveraging cutting-edge technologies for test automation within the UiPath platform. Attendees will delve into the integration of generative AI, a test automation solution, with Open AI advanced natural language processing capabilities.
Throughout the session, participants will discover how this synergy empowers testers to automate repetitive tasks, enhance testing accuracy, and expedite the software testing life cycle. Topics covered include the seamless integration process, practical use cases, and the benefits of harnessing AI-driven automation for UiPath testing initiatives. By attending this webinar, testers, and automation professionals can gain valuable insights into harnessing the power of AI to optimize their test automation workflows within the UiPath ecosystem, ultimately driving efficiency and quality in software development processes.
What will you get from this session?
1. Insights into integrating generative AI.
2. Understanding how this integration enhances test automation within the UiPath platform
3. Practical demonstrations
4. Exploration of real-world use cases illustrating the benefits of AI-driven test automation for UiPath
Topics covered:
What is generative AI
Test Automation with generative AI and Open AI.
UiPath integration with generative AI
Speaker:
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
Driving Business Innovation: Latest Generative AI Advancements & Success StorySafe Software
Are you ready to revolutionize how you handle data? Join us for a webinar where we’ll bring you up to speed with the latest advancements in Generative AI technology and discover how leveraging FME with tools from giants like Google Gemini, Amazon, and Microsoft OpenAI can supercharge your workflow efficiency.
During the hour, we’ll take you through:
Guest Speaker Segment with Hannah Barrington: Dive into the world of dynamic real estate marketing with Hannah, the Marketing Manager at Workspace Group. Hear firsthand how their team generates engaging descriptions for thousands of office units by integrating diverse data sources—from PDF floorplans to web pages—using FME transformers, like OpenAIVisionConnector and AnthropicVisionConnector. This use case will show you how GenAI can streamline content creation for marketing across the board.
Ollama Use Case: Learn how Scenario Specialist Dmitri Bagh has utilized Ollama within FME to input data, create custom models, and enhance security protocols. This segment will include demos to illustrate the full capabilities of FME in AI-driven processes.
Custom AI Models: Discover how to leverage FME to build personalized AI models using your data. Whether it’s populating a model with local data for added security or integrating public AI tools, find out how FME facilitates a versatile and secure approach to AI.
We’ll wrap up with a live Q&A session where you can engage with our experts on your specific use cases, and learn more about optimizing your data workflows with AI.
This webinar is ideal for professionals seeking to harness the power of AI within their data management systems while ensuring high levels of customization and security. Whether you're a novice or an expert, gain actionable insights and strategies to elevate your data processes. Join us to see how FME and AI can revolutionize how you work with data!
GraphRAG for Life Science to increase LLM accuracyTomaz Bratanic
GraphRAG for life science domain, where you retriever information from biomedical knowledge graphs using LLMs to increase the accuracy and performance of generated answers
Full-RAG: A modern architecture for hyper-personalizationZilliz
Mike Del Balso, CEO & Co-Founder at Tecton, presents "Full RAG," a novel approach to AI recommendation systems, aiming to push beyond the limitations of traditional models through a deep integration of contextual insights and real-time data, leveraging the Retrieval-Augmented Generation architecture. This talk will outline Full RAG's potential to significantly enhance personalization, address engineering challenges such as data management and model training, and introduce data enrichment with reranking as a key solution. Attendees will gain crucial insights into the importance of hyperpersonalization in AI, the capabilities of Full RAG for advanced personalization, and strategies for managing complex data integrations for deploying cutting-edge AI solutions.
Full-RAG: A modern architecture for hyper-personalization
PQRI Measures
1. Centers for Medicare & Medicaid Services
2007 Physician Quality
Reporting Initiative (PQRI)
Coding for Quality:
The Measures
Module IV
June 13, 2007
1
2. Disclaimers
This presentation was current at the time it was published or uploaded onto the
web. Medicare policy changes frequently so links to the source documents
have been provided within the document for your reference.
This presentation was prepared as a tool to assist providers and is not intended
to grant rights or impose obligations. Although every reasonable effort has
been made to assure the accuracy of the information within these pages,
the ultimate responsibility for the correct submission of claims and response
to any remittance advice lies with the provider of services. The Centers for
Medicare & Medicaid Services (CMS) employees, agents, and staff make
no representation, warranty, or guarantee that this compilation of Medicare
information is error-free and will bear no responsibility or liability for the
results or consequences of the use of this guide. This publication is a
general summary that explains certain aspects of the Medicare Program,
but is not a legal document. The official Medicare Program provisions are
contained in the relevant laws, regulations, and rulings.
2
3. Disclaimers
The Medicare Learning Network (MLN) is the brand name for official CMS
educational products and information for Medicare fee-for-service providers.
For additional information visit the Medicare Learning Network’s web page
at www.cms.hhs.gov/MLNGenInfo on the CMS website.
Current Procedural Terminology (CPT) is copyright 2006 American Medical
Association. All Rights Reserved. No fee schedules, basic units, relative
values, or related listings are included in CPT. The AMA assumes no liability
for the data contained herein. Applicable FARS/DFARS restrictions apply to
government use.
The International Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9-CM) is published by the United States Government. A CD-ROM,
which may be purchased through the Government Printing Office, is the
only official Federal government version of the ICD-9-CM. ICD-9-CM is an
official Health Insurance Portability and Accountability Act standard.
3
4. Overview
• PQRI Introduction: Information about PQRI
• PQRI Tools: Implementing PQRI
• PQRI Principles: Understanding the
Measures
• PQRI Coding: Examples of Measures
• PQRI Readiness: Ensuring Success
4
5. PQRI Introduction:
Value-Based Purchasing
• Value-based purchasing is a key
mechanism for transforming Medicare from
a passive payer to an active purchaser.
– Current Medicare Physician Fee Schedule is
based on quantity and resources consumed,
NOT quality or value of services.
• Value = Quality / Cost
– Incentives can encourage higher quality and
avoidance of unnecessary costs to enhance the
value of care.
5
6. PQRI Introduction:
Focus on Quality
• PQRI reporting will focus attention on
quality of care.
– Foundation is evidence-based measures
developed by professionals
– Measurement enables improvements in care
– Reporting is the first step toward pay for
performance
6
7. PRQI Introduction:
The Process
Visit Documented in Encounter Form Coding & Billing
the Medical Record
NCH
Analysis Contractor National Claims Carrier/MAC
History File
Confidential Bonus Payment
7
Report Procurement Sensitive
7
8. PQRI Introduction:
Feedback Reports
• Confidential Feedback Reports
– enable quality improvement at the
practice level
– include reporting and performance
rates by NPI for each TIN.
8
9. PQRI Introduction:
Key Information
• Reporting period: Dates of Service
between July 1, 2007 through December
31, 2007
• No need to register: just begin reporting
• Must be an enrolled Medicare provider (but
need not have signed a Medicare
participation agreement)
• Need to use individual National Provider
Identifier (NPI).
9
11. PQRI Tools:
Where to Begin
• Gather information and educational
materials from the PQRI web page:
www.cms.hhs.gov/pqri on the CMS
website.
• Gather information from other sources,
such as your professional association,
specialty society or the American Medical
Association.
11
14. PQRI Tools: MLN 5640: Coding and
Reporting Principles
14
Procurement Sensitive
14
15. PQRI Tools: Coding for Quality
A Handbook for PQRI Participation
15
Procurement Sensitive
15
16. PQRI Tools: Coding for Quality
A Handbook for PQRI Participation
• Selecting measures and preparing to report
• PQRI coding and reporting principles for the
claims based submission of quality data codes
• Sample clinical scenarios for each measure, listed
by clinical condition/topic, describes successful
reporting (and performance where applicable)
• PQRI Glossary
• 2007 PQRI Code Master
• Sample implementation flow chart
16
17. PQRI Tools: Coding for Quality
A Handbook for PQRI Participation
Examples of Clinical Conditions/Topics
• Clinical Conditions • Clinical Topics
– Asthma – Advance Care Planning
– Cancer ( Breast, Colon, – Screening for Fall Risk
CLL, etc) – Imaging
– Chest Pain – Medication
– COPD Reconciliation
– CAD – Perioperative Care
– Depression
– Diabetes
– GERD
17
18. PQRI Tools: Measure- specific Data
Collection Worksheets
• Measure Specific
– Measure Description
– Worksheet
– Coding Specifications
18
19. PQRI Tools:
The Code Master
• Excel Spreadsheet
– a sequential list of all ICD-9-CM (I9)
– CPT ® (CPT4) codes (including CPT II Codes)
– CPT II exclusion modifiers that are included in
the 2007 PQRI.
19
21. Understanding the Measures:
Commonalities
• 74 unique measures associated with
clinical conditions that are routinely
represented on Medicare Fee-for-Service
(FFS) claims
– ICD-9-CM diagnosis codes
– HCPCS codes
21
22. Understanding the Measures:
Scope
• The measures address various aspects of
quality care
– Prevention
– Chronic Care Management
– Acute Episode of Care Management
– Procedural Related Care
– Resource Utilization
– Care Coordination
22
23. Understanding the Measures:
Construct
Clinical action required for reporting and
performance
________________________________
Eligible cases for a measure (the eligible
patient population associated with the
numerator)
23
24. Understanding the Measures:
Construct
CPT II Code
or
Temporary G Code
________________________________
ICD-9-CM
and
CPT Category I Codes
24
25. Understanding the Measures:
Quality Data Codes
Quality-Data Codes translate clinical actions
so they can be captured in the
administrative claims process
25
26. Understanding the Measures:
Quality Data Codes
• Quality-Data Codes can relay that:
– The measure requirement was met
or
– The measure requirement was not met due to
documented allowable performance exclusions
(i.e., using performance exclusion modifiers)
or
– The measure requirement was not met and the
reason is not documented in the medical record
(i.e., using the 8P reporting modifier)
26
27. Understanding the Measures:
The Performance Modifiers
• Performance Measure Exclusion Modifiers indicate that an
action specified in the measure was not provided due to
medical, patient or systems reason(s) documented in the
medical record:
– 1P- Performance Measure Exclusion Modifier due to Medical Reasons
– 2P- Performance Measure Exclusion Modifier used due to Patient
Reason
– 3P- Performance Measure Exclusion Modifier used due to System
Reason
• One or more exclusions may be applicable for a given
measure. Certain measures have no applicable exclusion
modifiers. Refer to the measure specifications to determine
the appropriate exclusion modifiers.
27
28. Understanding the Measures:
The Reporting Modifier
• Performance Measure Reporting Modifier
facilitates reporting a case when the patient
is eligible but the action described in a
measure is not performed and the reason
is not specified or documented
– 8P- Performance Measure Reporting
Modifier- action not performed, reason
not otherwise specified
28
29. Understanding the Measures:
Performance Time Frame
• Some measures have a Performance
Timeframe related to the clinical action
that may be distinct form the reporting
frequency.
– Perform within 12 months
– Most Recent
• Clinical test result needs to be obtained,
reviewed, reported one time. It need not
have been performed during the reporting
period.
29
30. Understanding the Measures:
Reporting Frequency
• Each measure has a Reporting Frequency
requirement for each eligible patient seen
during the reporting period
– Report one-time only
– Report once for each procedure performed
– Report for each acute episode
30
32. Coding for Quality
• NOTE: The following are examples of draft
worksheets that will be made available soon to
facilitate PQRI data capture and reporting.
• In some cases, the material upon which they are
based has changed. Final data worksheets and
supporting documents will be available on the
CMS PQRI website in advance of July 1, 2007.
32
33. Coding for Quality:
Example #1- Prevention
Measure #4 – Screening for
Future Fall Risk
33
41. Coding for Quality:
Example #3- Acute Episode of Care Management
Measure #55 –
Electrocardiogram (ECG)
Performed for Syncope
41
Procurement Sensitive
41
45. Coding for Quality:
Example #4- Procedural Related Care
Measure # 20 – Timing of
Antibiotic Prophylaxis –
Ordering Physician
45
Procurement Sensitive
45