PCR: Plan All-Cause Readmissions
Risk-adjusted ratio of observed to expected 30-day all-cause readmissions.
Measure description
Risk-adjusted ratio of observed to expected 30-day all-cause readmissions.
Eligible population
Inpatient discharges
Performance drivers
Star measure + CMS HRRP.
Documentation & PA strategy
Care transitions; med rec; follow-up scheduling.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure PCR measure?
Risk-adjusted ratio of observed to expected 30-day all-cause readmissions.
What drives performance on this measure?
Star measure + CMS HRRP.
How should clinicians document for this measure?
Care transitions; med rec; follow-up scheduling.
What is the eligible population?
Inpatient discharges
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