Points of Interest 04/03/2014

Points of Interest

 

Ryan budget includes big changes to Medicare, Medicaid

A new House Republican budget for fiscal 2015 relies on big changes to Medicare and a repeal of the Patient Protection and Affordable Care Act to help cut government spending by $5.1 trillion over the next 10 years.

Reform Update: States seek contested Medicaid alternatives, cuts Proposals from conservative-led states looking to expand their Medicaid coverage in alternative ways have prompted worries among healthcare providers and patient advocates that proposed changes may mean some benefits are discontinued.

Revealing industry payments to docs could spur legislation on conflicts: experts

The public will learn for the first time this fall exactly how much their doctors are paid by the drug companies and device makers whose products they use. But don't expect it to be the end of the inquiry.

ICD-10

In order to stay on track with the ICD-10-PCS transition, coders should now be actively studying the new coding set and testing their working knowledge. While the task of learning a system with such a greater number of codes and such detailed documentation requirements may seem overwhelming, it becomes easy with the right resources. Accuchecker is the tool to assist you. Currently with AccuChecker you can work with both sets  (ICD-9 & ICD-10) of diagnosis codes.

For details ,call us :  305-227-2383 or 1-877-938-9311.

 

New Report Shows Significant Increases in PQRS and eRx Program Participation in 2012

Today, CMS released the 2012 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Experience Report, highlighting a significant increase in participation in both the PQRS and eRx programs.

 Physician Quality Reporting System

Physician Quality Reporting System (Physician Quality Reporting or PQRS) formerly known as the Physician Quality Reporting Initiative (PQRI)

About PQRS

PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). 

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). 

 

Beginning in 2015, the program also applies a payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services.  This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. 

Avoiding 2016 PQRS Payment Adjustments

For Individual Eligible Professionals

 

Eligible professionals can avoid the 2016 payment adjustment by meeting one of the following criteria during the 2014 PQRS program year:

1. Meet the requirements to satisfactorily report or satisfactorily participate for incentive eligibility as defined in the 2014 PQRS measure specifications (same criteria as 2014 PQRS incentive eligibility)

2. Report at least 3 measures covering one NQS domain for at least 50 percent of the eligible professional’s Medicare Part B FFS patients via claims or qualified registry

• An eligible professional that reports fewer than 3 measures covering at least 1 NQS domain via claims or qualified registry- reporting will be subject to the Measure-Applicability Validation (MAV) process, which will allow CMS to determine whether additional measures domains should have been reported.

3. Participate via a qualified clinical data registry (QCDR) that selects measures for the eligible professional, of which at least 3 measures covering a minimum of 1 NQS domain AND submits measures for at least 50% of applicable patients seen during the participation period to which the measure applies

For Group Practices

 

Group practices participating in the Group Practice Reporting Option (GPRO) can avoid 2016 payment adjustments by meeting one of the following criteria during the 2014 PQRS program year:

 

1. Meet the requirements for satisfactorily reporting for incentive eligibility as defined in the applicable 2014 PQRS measure specifications

2. Report at least 3 measures covering one NQS domain for at least 50 percent of the group practice’s Medicare Part B FFS patients via qualified registry

• Report 1-8 measures covering 1-3 NQS domains for which there is Medicare patient data (subjecting the group practice to the MAV process*), AND report each measure for at least 50% of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies.

 

*A group practice who reports fewer than 3 measures covering 1 NQS domain via the registry-based reporting mechanism will be subject to the MAV process, which would allow CMS to determine whether a group practice should have reported on additional measures.

 

 

For more details regarding this , contact AccuChecker :

305-227-2383  or 1-877-938-9311

 

 

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