Posts tagged PQRI
Anthem BCBS of Indiana Climbs On Board the Pay-For-Performance Bandwagon
Oct 13th
As regular readers of this blog may recall, last year, Medicare implemented its Physician Quality Reporting Initiative,which is also known as PQRI. Doctors who satisfied the quality of care and reporting requirements under PQRI received bonuses equal to 1.5% of their 2007 reimbursements.
A very limited number of small to medium size practices have opted to participate in PQRI due to the onerous reporting requirements (which, realistically speaking, can only be satisfied by EMR users) and the modest financial incentive. While providers have not embraced Medicare’s PQRI, many have been more receptive of the quality of care initiatives launched by such commercial payers such as Blue Cross Blue Shield.
Anthem Blue Cross and Blue Shield of Indiana (Indiana BCBS) has just announced that it will be following the emerging industry trend of offering bonuses to providers who follow its quality of care recommendations. Indiana BCBS’s bonus program, which is focused on primary care providers, will allow providers to earn a bonus equal to as much as 10% of their annual reimbursements.
As to the mechanics of the program, the Indianapolis Star explains that it is “based on information gleaned from the Indiana Health Information Exchange’s Quality Health First program… an Indianapolis-based nonprofit company that operates a widely used messaging service that allows thousands of area health-care providers to access lab results and other medical information securely over the Internet. Such data allows IHIE to generate reports for its Quality Health First program that tells doctors which of their patients have received recommended screenings and care.”
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances
How to Earn Your Electronic Prescribing Bonus
Jul 21st
In recent blogs, we focused on Congress’ carrot and stick approach to encourage e-prescribing. As we discussed, providers who implement e-prescribing could receive Medicare bonuses (above and beyond the Medicare fee schedule payments) equal to 2% 
of their annual Medicare collections. However, providers who do not implement e-prescribing will eventually see their reimbursements drop below the standard amounts set forth in the Medicare fee schedule. To qualify for an e-prescribing bonus, the following requirements must be met:
- A provider must submit a “sufficient number” of prescriptions (aggregate of electronic and paper) under Part D. Unfortunately, “sufficient number” has not yet been defined, but it will be clarified by the Secretary.
- A “sufficient number” of the “sufficient number” of aggregate Part D prescriptions must be submitted electronically (wow, only the government, or a lawyer, could make it this convoluted!). Again, “sufficient number” has not yet been defined, but it will be clarified at a later date.
- The provider must use e-prescribing technology that meets the minimum technical requirements.
- If there are any PQRI measures that directly relate to e-prescribing, the provider must report such PQRI measures in at least 50% of the situations wherein the same are “reportable.”
In the next blog, we will focus on another groundbreaking change that is coming to the e-prescribing world.
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances
Medicare Reimbursement Cuts of 10.6% Scheduled to Take Effect on July 1, 2008
May 21st
As July approaches, the healthcare community is once again bracing itself for significant, scheduled Medicare reimbursement cuts. Those who have been following the news or reading this blog for more than one year will agree with Yogi Berra that “it’s like déjà vu all over again.”
Unless congress is able to intervene, Medicare physician reimbursements will be reduced by 10.6 percent on July 1st. Thereafter, reimbursements will be slashed another 5 percent as of January 1, 2009.
Save Medicare Act of 2008 (#S. 2785) represents one of the many bipartisan efforts to stop (or at least stall) the impending reimbursement cuts. The bill would not only replace the scheduled cuts, but would increase existing reimbursement levels by 1.8% in 2009. Moreover, the bill would extend the present Physician Quality Reporting Initiative (sometimes referred to as PQRI), with its associated bonuses, through 2010.
We’ll continue to follow the progress of the Save Medicare Act of 2008 and other similar efforts. Please check back as we will be continuing to provide updates regarding the status of the scheduled Medicare cuts.
Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances