Physicians Practice - September 2008 - (Page 35) PUBLIC POLICY many billing systems. These systems may reject claims that have a zero dollar amount on a line item, or they’ll mindlessly strip off any line item with a zero dollar amount before pushing the claim through. If that happens, your PQRI information will never get reported, possibly unbeknownst to you until it’s too late. If your billing software is indeed complaining about PRQI submissions, then you’ll have to make adjustments. Translation: Your vendor will have to program some workaround, at your expense. The sheer influx of more line items can also cost you. Adding too many line items to an electronic claim could cause it to automatically bump over into two claims. Be sure to check with your billing system on whether this will cost you more to process. WHAT ABOUT 2008 AND BEYOND? PQRI BASICS Here are our tips for PQRI participation: • Read the directions. Yes, there are many rules. Take time to learn them. CMS has made an effort to explain things at www.cms.hhs.gov/pqri. involved is on board, both attitudewise and skill-wise. Clearly, how Medicare’s pay-forperformance program will play out is unclear. Both supporters and naysayers agree on one thing, though: It’s here to stay. “That’s why we’re participating,” says Peterson. “We think CMS will take that approach.” He’s fairly certain that when PQRI becomes a true pay-for-performance program it will reduce reimbursements. “I don’t think we’ll get more. We’ll hold onto what we have,” he says. Like Schreiber, Peterson questions the validity of using pay-for-performance to improve overall quality, despite his own involvement. He says he appreciates the industry’s intent to reduce medical errors, but he’s not convinced that PQRI will accomplish this. “The people who dream these things up don’t have experience in the trenches,” he says. An effective program or not, use this premandatory phase wisely. “It’s a good time to get the kinks out,” says Peterson. Here are some of the changes CMS made for the 2008 program: • The list of reportable measures grew from 74 to 119, allowing many more physicians to become eligible. • The payout cap was eliminated. • Congress required CMS to develop structural measures, not just clinical measures. This was done to encourage physicians to adopt EMR and/or e-prescribing systems. • In addition to the full-year program, CMS now offers a half-year version, for which you need only report on 15 consecutive patients for a single measure, instead of 80 percent of all patients for all measures you select. Payout is smaller, but you’re done much quicker. And 2009? Very, very unsettled right now, although there are some rumblings that next year’s program will increase the participation bonus from 1.5 percent to 2 percent. This bonus is a carrot to lure doctors into participating, and the government is keen on increasing program enrollment, according to Robert Bennett, • Train your staff. Make sure everyone • Keep it simple. You only have to report on three measures (for now), and you won’t receive a higher bonus for going beyond that threshold. However, consider adding just one extra measure to provide a safety net in the event you reported one measure incorrectly. Underreporting will result in you getting squat. you do anyway, and that are not tightly linked to patient adherence. government affairs representative for the Medical Group Management Association: “What the government is contemplating is, ‘If we got 16 percent [of eligible physicians] to participate [with a 1.5 percent bonus], what can we get for 2 percent?’ Congress really wants physicians to participate.” So much so that it would consider authorizing a “stick” to go along with the carrot? Say, a 1.5 percent bonus for those who opt in, and a 0.5 percent penalty for those who beg off? It’s possible, says Bennett. Stay tuned. This behemoth of a program is still cutting its teeth. Physician reactions, though, are all over the map, admits Bennett. “We’ve heard from people who are doing it to learn. Others who think it’s their obligation to participate in Medicare. We’ve also heard from some angry people, claiming this is nothing more than bureaucratic red tape and double-checking up on physicians. It’s a legitimate concern. But the counter of that argument is if you’re going to build something up, you’ve got to start small.” Either way, given that PQRI is not going away, getting involved with it now gives you a chance to have a voice in shaping the final product, while getting a jump on understanding CMS’ data-reporting requirements. While the government hasn’t said that the program will become mandatory for all practices that accept Medicare, or that it will penalize those who stay out, who’s kidding whom? • • Choose wisely. Go for measures that • Bounce-proof your billing service. Shirley Grace is an associate editor on staff at Physicians Practice. She can be reached at sgrace@physicianspractice.com. You don’t want claims rejected because of PQRI reporting. Make sure the billing service’s practices are compatible with PQRI’s reporting rules, such as accepting a zero in the dollar amount line. such as Sermo, and discuss your experiences or ask questions. • Talk to others. Join an online forum, WWW.PHYSICIANSPRACTICE.COM SEPTEMBER 2008 | PHYSICIANS PRACTICE | 35 http://www.cms.hhs.gov/pqri http://WWW.PHYSICIANSPRACTICE.COM
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