Issue 13 • Winter 2009
 

PQRI 2009: CMS Increases Financial Incentives

Billing and coding accurately is vital to successful reporting

 

Now more than ever, practices are searching for creative ways to trim operating budgets, increase revenue, and thrive during a challenging economic downturn. One way physicians can earn extra income in 2009 is to participate in the Physician Quality Reporting Initiative (PQRI).

Eye care providers who successfully report PQRI quality information in 2009 may earn a bonus payment of 2 percent of their total allowed charges for covered Medicare Physician fee schedule services. Allowable charges are that portion of the submitted charges that is approved for Medicare payment (including the deductible and coinsurance).

EMR Software Tip: As you search for the right EMR system, make sure your software includes built-in PQRI customized scripts. Did you know that maximEyes EMR software will prompt you when a patient qualifies for PQRI 2009 then will automatically add the codes to the Superbill? MaximEyes also checks to see if the patient has Medicare, verifies the patient’s age at the time of exam, reviews diagnoses and procedure codes, and reviews specific items detailed under the PQRI measures.

 

PQRI and E-Prescribing Quick Facts
1.   The PQRI program was created as part of the Tax Relief and Healthcare Act of 2006.
2.   PQRI is measured by “evidence-based standards and procedures,” that were developed by professionals and endorsed by national consensus groups, such as the National Quality Forum (NQF) and AQA (formerly the Ambulatory Care Quality Alliance).
3.   PQRI is still a voluntary program; no registration is required. A physician can choose whether to report quality information to Medicare under the PQRI program. Start reporting early to ensure the claims count toward successful reporting.
4.   Reporting period is January 1, 2009 through December 31, 2009.
5.   For 2009, there are 153 quality measures; of those, 8 are related to eye care (Measure 139, Cataracts, is only for surgeons). For a complete list of Measures and Codes visit the CMS website.
6.   In 2009, CMS removed PQRI Measure 125 (e-prescribing) and will use the Medicare Improvements for Patients and Providers Act (MIPAA) incentive program instead. In 2009 and 2010, physicians who successfully e-prescribe may receive a bonus payment of 2 percent of their overall Medicare Part-B reimbursement. Amounts will vary depending on the annual allowable Medicare Part-B billings. In 2011-2012, the reward for
 
 

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  e-prescribing will be 1 percent, while the penalty for not e-prescribing begins in 2012. Learn more about maximEyes’ built-in e-prescribing link.
7.   Physicians must report a minimum of 3 quality measures at least 80% of the time on claims submitted during the PQRI 2009 reporting period.
8.   Claims must be submitted on the CMS-1500 paper form or the electronic 837-P form.
9.   CMS uses the taxpayer identification number (TIN) as the billing unit. All incentive payments earned will be paid to the holder of the TIN.
10.   Incentive payments will be paid out as a one-time lump sum in mid 2010.
 

Informative Industry Resources for PQRI and E-Prescribing

For specialty- or practice-specific questions, contact your professional organization or specialty association for guidance.

 
CMS PQRI Website
  2009 PQRI Measures List and Descriptions
  2009 PQRI Measures Specifications Manual for Claims and Registry
  Medicare’s Practical Guide to the E-Prescribing Incentive Program
  2009 E-Prescribing Incentive Program Made Simple
  American Optometric Association (AOA)
  American Optometric Association PQRI PowerPoint Presentation
  American Academy of Ophthalmology (AAO)
  Medicare Learning Network
 
     
 

Disclaimer: The information in this article was current at the time of the posting of this e-newsletter (January 14, 2009).  First Insight has made every effort to provide you with the most recent information. Because CMS laws, regulations, and rulings change frequently, refer to the Medicare Program provisions on the CMS website as the official source of PQRI information, or contact your professional organization for guidance.

 
     
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