IM Quality Measures Participation Questionnaire
IM Quality Measures Participation Questionnaire
(Please fill this form out completely and click the "Submit" button at the bottom)
Contact Info:
Group Name:
First Name:
Last Name:
Email:
Phone:
Configuration Info:
What percentage of physicians practicing under your tax ID will be participating in PQRI?
What percentage of those participating physicians perform their billing on PDAs?
When would your organization be ready to begin entering quality measure information with their bills?
Which bill submission method does your organization use within Practice Manager? (This is indicated by the check box selected on your Admin Settings tab.)
Discharge
Concurrent
If you use Practice Manager in a Concurrent Billing mode, does your billing company/group actually send bills to payers as they receive them from your organization, or do they hold them until the patient is actually discharged? (This is information your billing company should be able to provide to you.)
Sends them as they are received
Holds them until discharge
What value is recorded in your current Charge Lag setting in Practice Manager? (This is the “Only Show Bills Older than x days in Billing Report” setting on your Admin Settings tab.)
Which measures are you interested in reporting? Check all that apply (a minimum of three is strongly recommended):
5 - ACE inhibitor or ARB therapy for LVSD
6 - Antiplatelet therapy for CAD
7 - Beta-blocker therapy for CAD with prior MI*
31 - (Stroke)DVT prophylaxis for IS and ICH
32 - (Stroke)Discharged on antiplatelet therapy
33 - (Stroke)Anticoagulant therapy for AF at discharge*
34 - (Stroke)t-PA considered
35 - (Stroke)Screening for dysphagia
36 - (Stroke)Consideration of rehabilitation services
47 - Advance care plan
111 - Pneumonia Vaccination for Patients 65 Years and Older
115 - Advising Smokers to Quit
* Note: Measures 7 and 33 are available for internal tracking of quality/performance data, but will no longer count towards the minimum of 3 reporting measures required for successful PQRI participation.
Please add any additional information you feel will be useful and list any specific questions or topics you may be interested in discussing further during your follow-up conversations:
