Pathologists Can Still Earn Medicare PQRI Incentives
Excerpt from PSA Interview
The Dark Report/May 10, 2010
During 2010, the Medicare Physician Quality Reporting Initiative (PQRI) will pay a 2% bonus to pathologists who register and report data on 80% of their cases for the specified CPT codes. However, independent pathology laboratories still cannot participate in the PQRI program. Also, PSA, LLC reports it can be challenging to audit the Medicare PQRI bonus amount paid at year’s end against the actual amount that was billed to Medicare by individual pathologists for the CPT codes included in the PQRI program.
It’s often said that what the government gives with one hand, it takes away with the other. That statement might accurately describe Medicare’s Physician Quality Reporting Initiative (PQRI), at least as it pertains to pathologists.
Now entering its third year, the PQRI program does offer pathologists a way to get paid more for selected types of cases. But upon receipt of the bonus checks at year end, it is not easy to determine whether Medicare accurately paid the correct bonus amount to participating pathologists.
“When PQRI was introduced two years ago, we told our pathology billing clients that we believed CMS would require participation in PQRI at some point in the future,” recalled John Outlaw, PSA’s Chief Compliance Officer. “Unfortunately, we were right. With passage of the new healthcare reform law in March, PQRI reporting bonuses will be scaled back to 1% beginning in 2011and to 0.5% from 2012 through 2014. Beginning in 2015, physicians who do not report will have their payments reduced by 1.5% if they do not participate, and the penalty for not reporting increases to 2.0% in 2016.
Can Still Earn Bonus in 2010
Having made that observation about the future mandatory reporting requirement, Outlaw pointed out that any pathologist who would like to earn the 2% Medicare PQRI bonus for 2010 can still register and start reporting quality measurers for breast cancer and colon cancer resection beginning July 1, due to the new 6 month reporting option. “If they report on 80% of these measures from July 1 through December 31, 2010, they will be eligible for a bonus from CMS at year end,” explained Outlaw. According to Outlaw, this mid-year registration is a new feature to the PQRI program.
Accuracy of Bonus Payment
Another challenge to participation in the PQRI program is determining the accuracy of the bonus payment sent by Medicare. “When the Centers for Medicare and Medicaid Services (CMS) distributed reimbursement checks in the fall of 2009 to pathologists who participated in PQRI in 2008, it was a lump sum total for a single pathology practice,” said Stephanie Denham, CPA, PSA’s Audit Supervisor. “That made it difficult to precisely map the 1.5% bonus paid against the total amount billed to Medicare that year,” she explained. “After all, the correct bonus payment amount must be verified by each individual pathologist, since some qualified for the PQRI bonus that year and some did not.”
Tracking PQRI Data
“Because of the time-consuming procedures required to go back to Medical officials to get a more detailed accounting of the PQRI bonus payment, we’ve built edits and features into our software to make it easy to record the data on how pathologists are complying with these PQRI measures,” said Al Sirmon, CPA, PSA’s President. “Going forward, our clients have a detailed audit trail that will help us verify the accuracy of future PQRI payments.”
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