Are PCPs aware that physicians’ practices are
receiving thousands of dollars in additional revenue for reporting measures to
Medicare (PQRS Measures) and to HMOs and Commercial Plans (HEDIS Measures)? Are
you participating?
You can summarize that coding services properly and
reporting the information to insurance carriers will improve the quality of
care, will reduce the spiraling cost of healthcare, will bring your practice to
a higher level of performance and most important will increase your revenue considerably.
But what are PQRS and HEDIS measures?
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.
·
EPs who do not satisfactorily report data
on quality measures for covered professional services during the 2014 PQRS
program year will be subject to a 2% payment adjustment to their Medicare PFS
amount for services provided in 2016. BOTTOM
LINE YOU MUST PARTICIPATE.
About HEDIS
·
The Healthcare Effectiveness Data and
Information Set (HEDIS) is a tool used by more than 90 percent of America's
health plans to measure performance on important dimensions of care and
service. Altogether, HEDIS consists of 81 measures across 5 domains of care.
Because so many plans collect HEDIS data, and because the measures are so
specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples"
basis
·
Performance measurement isn’t just for health plans. Physicians
are increasingly participating in performance measurement activities,
especially in the context of pay-for-performance initiatives that are taking
shape across the country. Measurement at all levels of the system is fast
becoming the norm in health care.
The next three to five years will be crucial for
physicians, ICD10 starts next year and it is known that the new coding system
will impact financially physicians’ practices, besides ICD10, the transition
from the fee-for-service system to the Pay-for-Performance (P4P) alternative is
a lengthy process and it will intensify.
The implementation and daily use of EMR systems, reporting
Pay-for-Performance measures, coding diagnoses to the highest level of
specificity and the need to incorporate Category II procedures into the
reimbursement cycle demands a bigger involvement of physicians and office
staff, coding and documenting services in the practice.
Computers in
physician offices require software that includes ICD10 and online systems with
the latest reference material that simplifies documentation and coding of the
P4P methodologies.
HPP Management
Group, Corp. developers of the AccuChecker Product Line packaged the right coding
software and the most economical choice “The 3 in 1 Solution”
·
AccuChecker
OnLine the online database,
·
ICD-9/ICD-10
(combined into one coding system) and
·
The
coding modules for the two P4P Modules
o The service includes FREE training and
ongoing support!
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