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.
Healthcare acronyms and terms are confusing enough and the complexity of PQRS terms with similar sounding elements can make it even worse. We talk to so many clients who innocently confuse group measure reporting with the Group Practice Reporting Option (GPRO). They are not the same and depending on your situation, you want to use the one best for your practice.
Ironically, the SGR became unsustainable within a few years of its introduction. Nearly every year for the past decade and a half, the SGR formula threatened healthcare providers (doctors of medicine, osteopathic doctors, nurse practitioners, physician assistants, and others paid under the fee-for-service [FFS] reimbursement system) with payment reductions. And in nearly all of those years, Congress stepped in to prevent the cuts. These temporary fixes only compounded potential reductions in the years ahead.