Answer to Question 1
The physician quality reporting system is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible providers. The PQRS was established by the Centers for Medicare and Medicaid Services.
Answer to Question 2
In prospective review/precertification the service is examined before it is provided. Data are collected from the patient and the physician to compare the data to appropriate criteria. If the standards are met, the service can be provided. If the standards are not met, a physician advisor may be asked to review the case and make a determination. In retrospective review, care is looked at after it is given. Data are collected from a sample of medical records, and the information from the record is compared to the appropriate standards. Feedback then is given to the caregiver regarding inappropriate care provided.
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