KEY FACTS: PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)
PQRI is a precursor to Medicare pay for performance (P4P) or quality incentives established by the Tax Relief and Healthcare Act of 2006 (TRHCA). The first quality reporting period will be July 1, 2007 through December 31, 2007.
Payment Amount: Congress budgeted $1.35 billion but the payment amount per provider…
View David Harlow’s HealthBlawg for an update onn CMS PQRI.
The General Accounting Office (GAO) has issued a report recommending physician profiling, which they define as identifying efficient physicians. The entire report, i.e., GAO-07-307, is available at the following link: http://www.gao.gov/new.items/d07307.pdf
Following are key findings:
GAO estimates that physician account for 20% of the total health care expenditures, but influence 90% of total expenditures through referrals…
TEN TOP PHYSICIAN BILLING ERRORS
Highmark Medicare Services recently presented a teleconference on the ten top reasons for rejections and most common billing errors. The list is as follows:
1. No performing PIN
2. No verification HIC/entitlement
3. Invalid procedure code
4. Incomplete physical exam information for chiropractic services
5. Missing or incomplete modifiers
6. Missing…
Highmark Blue Shield has expanded its list of procedures requiring pre-authorization. The full list of procedures is available on the Highmark Resource Center website:
https://www.highmarkblueshield.com/pdf_file/rc-hbs-auth-code-update-april-2007.pdf
It includes a significant number of home health and DME services, prosthetic devices and other services.
Highmark has also removed two procedures from the list, i.e., pharmacologic management (90862) and the…
2007 Physician Quality Reporting Initiative (PQRI)
National Provider Conference Call with Question & Answer Session
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host the first in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 3:00 p.m. …
MEDICAL PAYMENT ADVISORY COMMISSION (MEDPAC) REPORTS
DEAL WITH PRACTICE EXPENSE METHODOLOGY, SGR AND P4P:
MedPac reported to Congress on a variety of issues in March of 2007. MedPac predicted that the new practice expense methodology will produce a 7% E&M increase, but an 8-9% decrease for major imaging procedures by 2010. MedPac concluded that Sustainable Growth Rate…
PRESCRIPTION FOR PENNSYLVANIA – GOVERNOR RENDELL’S PROPOSAL
FOR PENNSYLVANIA HEALTH CARE REFORM
Representatives of Governor Rendell’s administration reported at the Pennsylvania Bar Institute Annual Health Law Institute that Governor Rendell’s “Prescription for Pennsylvania,” the comprehensive state health care reform program, is expected to be presented to the Pennsylvania Legislature before the end of the month. Prescription for…
The Centers for Medicare and Medicaid Services (CMS) has quietly reversed itself on the new standards for Independent Diagnostic Testing Facilities (IDTFs). Transmittal 187, which established new standards for IDTFs and was scheduled to be effective as of February 26, 2007, was rescinded without explanation. Therefore, some of the more significant changes, such as:
§ …
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the 2007 Physician Quality Reporting Initiative (PQRI) webpage is now available.
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system …
