Want a bonus check? CMS has a program for you
By fulfilling selected quality measures, you can garner an additional 1.5% of your total Medicare earnings
The Centers for Medicare and Medicaid Services (CMS) launched its Physician Quality Reporting Initiative (PQRI) July 1. This program, voluntary in 2007, rewards physicians for reporting a designated set of quality measures. Physicians who successfully report these measures under established criteria earn a bonus payment, subject to a cap, of 1.5% of their total allowed charges for covered services paid under the Medicare physician fee schedule.
Quality measures are reported on the CMS claim form just as any other service would be, except that no charge is billed for the reported measure. The time frame established for the reporting of these measures is July 1 through December 31 of this year. Although there are plans to continue the program in 2008, it is unclear whether funds will be available for a bonus in 2009, and the measures for 2008 will be different from those used in 2007.
To calculate the potential bonus amount when at least 3 measures are successfully reported, use your total Medicare income for the past 6 months. If you received $60,000 for treating Medicare patients from January 1 through May 31, for example, and Medicare income has been steady, expect a lump sum bonus of $900 in mid-2008.
How do I report an intervention?
Good news: You do not have to register to participate in PQRI; you need only report the selected quality measures each time you submit a claim for the patient service to which the quality measure applies. Criteria for reporting (and then receiving the bonus in mid-2008) for these quality measures are as follows:
- Select the quality measures that apply most often to your practice (see the TABLE)
- Enter the PQRI codes on block 24D of the CMS 1500 claim form with a $0.00 dollar amount; if your system does not allow this amount to be entered, change it to $0.01
- There must be a match between the acceptable CPT or ICD-9 code reported for the overall service with a CPT Category II or HCPCS “G” code designated as the quality measure, as listed in the Medicare specifications file (www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage)
- Apply any applicable allowed modifier that explains why the quality measure was not assessed:
The measure specifications are organized to provide specific information:
- Measure title
- Instructions on reporting, including frequency, time frames, and applicability
- Numerator coding
- Definition of terms
- Coding instructions
For example: Measure 48 documents the percentage of female patients age 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months. The denominator for this measure is represented by the reported evaluation and management (E/M) service approved for this measure (ie, 99201–99205 [new patient E/M service], 99212–99215 [established patient E/M service], 99241– 99245 [outpatient consultation], 99387 [preventive new patient service], 99397 [preventive established patient service], 99401–99404 [preventive counseling visits]), along with the information on the claim that indicates the patient’s age and sex.
The numerator part of the measure is represented by a CPT Category II code with or without a modifier. CPT code 1090F (presence or absence of urinary stress incontinence assessed) would be reported if the presence or absence of urinary incontinence was assessed, but a modifier 1P is placed in box 24E of the claim form if you have documented a medical reason why this was not assessed, or modifier 8P if it was not assessed but the reason was not documented.
The Physician Quality Reporting Initiative: 10 measures may apply to ObGyn practice in 2007
CONSTRAINTS AND COMMENTS