News and Updates From Our Blog

While it may seem daunting to consider all the 2017 changes while in the midst of the current 2016 PQRS reporting period, consider it we must. The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) ended the sustainable growth rate (SGR) averting annual congressional action necessary to stop negative adjustments to the Medicare Physician Fee Schedule (PFS). As part of the transition CMS mandated a transition from payment based on volume of billed services to quality metrics.  On October 14th, CMS released the final rule for the revamped Quality Payment Program (QPP).

"Better late than never" is not just a phrase, it’s a way of life for those finding out about quality metric reporting at the 11th hour. Doctors and medical providers in general are well-known for our procrastination. We can perform in a pinch and, hell, we are trained to react in emergencies, not plan for them—save for our training. However, in many aspects of our day-to-day life, being late is not okay.

As a national coding and reimbursement expert for nearly twenty years, multiple coding/billing certification and credentials, and commercial payer work experience to boot, I thought learning PQRS would be, well, pretty easy. I mean becoming a national expert in E&M coding, mastering ICD-9 and now ICD-10, understanding community health center coding and billing amidst a combination of ANSI 837s (I, P, and D) as well as remits via 835 files… certainly a few weeks of quick study should get me pretty up to speed. Wow, was I wrong. The system is complex and onerous.