Most people hate change. It’s hard and often challenging. However, change can also be an opportunistic adventure. At the end of the day, it doesn’t matter whether you like change. In the world of CMS reimbursement, change requires expanded participation… or in 2017, any participation! In short, participate or be penalized. Medicare is giving out “gifts”, and there’s no fat man running around in a red suit this time of year. No, this is literally as easy as getting a participation trophy in t-ball these days.
Evidence based medicine (EBM) has become the mainstay for insurance denials; i.e., the evidence that standard deviations should not be normative and the foundation for why doctors should be automatons in how care is provided before ever thinking about the uniqueness of the patient. This philosophy is now upon us.
Decide how you are going to report NOW for 2017. Start collecting data now! If you know the measures now, it doesn’t matter what system you are on, you can build easy ways to track measures if you know what they are.
When reimbursement is tied to performance (as it currently is in the Physician Quality Reporting System (PQRS) 2016 reporting season), how do we navigate between what is "right" and what will get us paid?
Registries are in high gear now reviewing boatloads of data as providers finalize their 2016 PQRS submissions. What is the best way to honor the supposed Center for Medicare & Medicaid Services (CMS) "spirit" and intention of the program (to improve quality and patient care) and still receive the maximum reimbursements to which the provider believes s/he is entitled to receive for services rendered? As a qualified registry, that has been vetted by CMS, we walk the fine line everyday of providing a balanced response to this question.
2017 is almost upon us! Are you freaking out because we’re in the last few weeks of 2016 PQRS reporting and you haven’t actually participated in the program yet? Have you just received a letter from CMS telling you that you were penalized from last year, and you’re not sure what to do about any of it? Fear not, there’s a solution–and it’s not as scary as you think!
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).
It’s that time of year again where everyone eagerly awaits their “Report Cards” from CMS; in other words, the Quality & Resource Use Reports (QRUR) are coming! Most folks don’t even know the reports come directly from CMS via their EIDM account, NOT from their registry or EMR vendor. So, let’s start by getting everyone to understand where to get these “report cards” and, once you know how to obtain them, what they mean for you and your practice!
"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.
Few know the federal False Claims Act (FCA; today found via 31 U.S.C. Sections 3729 through 3733) dates back to 1863 when the US government was battling to maintain geographic solvency amidst the Civil War and clashing with swindlers selling decrepit livestock, malfunctioning weapons, and rancid rations to the Union Army.
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.