Pqrs

[Pain Applicant1]

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Anyone know how to submit the codes for this? I have received my MU reimbursement and have figured that out but still can't figure out PQRS. I know which measures I want to submit but how do you go about transferring these measures into G codes to submit with claims? Anyone?

 

[bedrock]

what the hell is that?

 

[clubdeac]

It's some bull**** in obamacare that all practices will have to follow and comply with. And if you don't spend the time and money..... you'll be fined! Seriously this stuff just makes my blood boil. It's definitely getting time for a physician strike/revolt

 

[Ducttape]

It's some bull**** in obamacare that all practices will have to follow and comply with. And if you don't spend the time and money..... you'll be fined! Seriously this stuff just makes my blood boil. It's definitely getting time for a physician strike/revolt

PQRS was initiated at PQRI in 2006 - its "incentive" money for doctors to submit to Medicare Part B. Dont do medicare? dont worry bout it.

Also,
i didnt realize that Obama was in office at that time.

 

[clubdeac]

PQRS was initiated at PQRI in 2006 - its "incentive" money for doctors to submit to Medicare Part B. Dont do medicare? dont worry bout it.

Also,
i didnt realize that Obama was in office at that time.

Oh.... I just hate Obama and blame everything on him. Guess I didn't know the full story, oops 🙄

 

[Pain Applicant1]

No more incentive to do it, if not done by 2013 you will be fined on all of your Medicare patients. All private practice folk need to know this.

 

[clubdeac]

No more incentive to do it, if not done by 2013 you will be fined on all of your Medicare patients. All private practice folk need to know this.

Ha! I knew there was a fine involved. And you mean by 2014 right? Otherwise I'm getting fined as we speak!😱

 

[pastafan]

Ha! I knew there was a fine involved. And you mean by 2014 right? Otherwise I'm getting fined as we speak!😱

Oh, you can be "fined" without even knowing it by CMS. There is a requirement for electronic prescribing that has several exemptions based on locality. After seeing the requirements I fit several of the exemption categories. I'm not required to electronically prescribe.

Later I discover that my reimbursement for my practice has been cut 1%. It turns out that I had to specially apply for the exemption to be exempt. Got screwed for the entire year due to this. The total dollar amount after tax is not huge but I still get mad thinking about how they operate.

 

[stim4u]

never had to submit G coded for PQRI, or eprescribing codes, or other bull..t codes to medicare during the Bush years. This is all obamacare at its finest. This is the governments means to fine doctors, cut reinbursement, all in the name of quality of care. "Affordability" care act has nothing to do with quality of care. the sytem will divide into the upper class care in the private practices and the rest in ACO's run by the bureaucrats..

 

[Ducttape]

never had to submit G coded for PQRI, or eprescribing codes, or other bull..t codes to medicare during the Bush years. This is all obamacare at its finest. This is the governments means to fine doctors, cut reinbursement, all in the name of quality of care. "Affordability" care act has nothing to do with quality of care. the sytem will divide into the upper class care in the private practices and the rest in ACO's run by the bureaucrats..

it was clearly established during the bush era.

it was ratified in 2006, established in 2007, and made permanent in 2008.

so you tell me how any of this is due to obamacare at its finest, when obama wasnt even sworn in until january 2009.

if you are going to argue about something, get your facts straight first, especially when rebuttals are posted above your post. looks pretty biased and invalidates arguments when simple facts like timelines are incorrect.

yes i know...
truth doesnt stop Fox News from reporting something...


ps payment penalty starts in 2015.

 

[Pain Applicant1]

Bush Smush, Obama Shmobama - Who cares? Fines start for 2015 if you don't complete it now.

You can complete eprescribing, it's easy. For every Medicare pt you see that you eprescribe for just submit claim G8553 on your HCFA form. You have to get 25 done this year unless you fulfilled it last year. You're already likely eprescribing so you might as well not get fined for it. Just do it, not worth the protest or fight with CMS.

Let's figure out this PQRS nonsense. I've been trying to figure this out for the past several months and am still lost. I have received my MU incentive and got that down. If you know PQRS, please post. I will when I find out more. I'll eventually figure it out.

 

[Pain Applicant1]

Okay, got it. I sat down this morning and spent some time learning it. It's the same as eprescribe, you just need to pick three additional codes to report and I don't believe that the eprescribe code could be one. I think I know which three I'm going with.

It seems that >50% of eligible patients must be reported so considering that we just past the half way mark through the year time is of the essence. If you don't start reporting right now it might be impossible to catch up.

 

[stim4u]

sport, how long have you been practicing??? Do you submit your codes or do you have a biller do it for you?? When did you first submit a e prescribing code or quality measure code?

Pretty simple questions. Never happened until obama years. Spin it all you want, but prove to me you submitted an e prescribing code or any quality measure prior to 2009, love to see it.
CMS and current penalties have never occurred before. Never had CMS send me threatening comparative chart (vs.my peers) until the obama years.

This is not make believe. I can care less what your political values are, the issue is that CMS is becoming more and more authoritarian. That is why I have cut my medicare patients in half....not worth my time or effort.

 

[Ducttape]

whether CMS is becoming more authoritarian was never addressed or discussed by me in this thread, because i agree with your opinion on that (esp. CRNAs, restrictions of injections, bundling of fees, etc.)


specifically, dont play the political game republican vs. democrat, with respect to pqrs. if you want, focus on the anti-physician attitude of Sebelius and CMS et al, cause that could be more productive, including if CMS made changes to programs established previously.

 

[stim4u]

again provide me with a superbill with a g -code, e-prescribing code, or quality measure back pain code from 2009 or earlier..... love to see it.

You cannot, because it did not exist my man....the current penalties and quality measure mandates are a functional of obama care 'health care reform'. This is an a-political statement.

 

[Ducttape]

again provide me with a superbill with a g -code, e-prescribing code, or quality measure back pain code from 2009 or earlier..... love to see it.

You cannot, because it did not exist my man....the current penalties and quality measure mandates are a functional of obama care 'health care reform'. This is an a-political statement.

STEP 3
Review the 2009 PQRI Measures List, which is available as a downloadable document in the Measures/Codes section of
the CMS PQRI web page at http://www.cms.hhs.gov/PQRI on the CMS website, and determine which PQRI
measures apply.
EPs who choose to report on individual measures need to select at least three measures to report on to be able to qualify
to earn a PQRI incentive payment.
EPs who choose to report measures groups need to select at least one measures group to report to be able to qualify to
earn a PQRI incentive payment for 2009.

2007 Physician Quality Report Initiative Program Re-Run Frequently Asked Questions

Webinar Questions & Answers:

Q: Are modifiers (1P or 8P) used with the 3250F PQRI code?

A: No. For PQRI measure #99, 3250F acts as a denominator exclusion code and therefore does not allow a modifier to be appended to it. Page 212 of the 2009 PQRI Measure Specifications Manual contains the following instruction, " If patient is not eligible for this measure because the specimen is not primary breast tissue (eg, liver, lung) report CPT II 3250F: Specimen site other than anatomic location of primary tumor

so PQRI had codes at least starting 2009. it may be that you were not aware of them, or they did not impact you.

finally, as final proof:

2007 Physician Quality Reporting Initiative (PQRI)

Page 6. G code discussion.

 

[PinchandBurn]

I don't know if you guys get the ASIPP news. Looks like MARVEL HAMMER is giving a webinar on this topic. Might be something interesting to look at.

 

[stim4u]

dude you are clueless, read the first sentence of your 2007 link or your so called 'proof':
"PQRI establishes a financial incentive for eligible professionals to participate in a VOLUNTARY
quality reporting program"

This program was not in effect and completely voluntary at best. There were no penalties or incentives. It did not impact anybody because it was not enforced or mandated at that time. Obamacare mandated it. Get it. NObody on this thread (or in this universe) sent out e prescribing codes or quality measure codes at that time....
I have no more time for this mindless and irrelevant conversation. I would recommend focusing your time on creating your own business or practice. Go out in the real world and figure out the true obtacles business owners face, instead of living in your pain management cave funded by some ACO/hospital manager. take care.

 

[Ducttape]

semantics. call it what you will. its always been mandated - it is federal legislation. participation is "voluntary".

in 2007, there were incentives - 1.5% increased pay.

its still considered completely voluntary, even with the penalty upcoming in 2015. they arent coming to offices to seize assets, clinics wont get sued, you wont lose your license.

it may be b.s. legalese to call it voluntary, but thats government speech for you.

i know you hate it, but dont have misconcieved facts about it, and go spouting those facts. thats gonna get you in trouble, or land you a job on some conservative talk show.

 

[stim4u]

Ducttape:
When has the government ever fined a physician for a voluntary program?Never. Not until after 2009. There have been penalties for the last 2 years, not in 2015.
Not sure what the confusion is. Voluntary became mandatory, and the penalties continue to rise unless you comply. This again began after 2009 not in 2015. What are you talking about? Look at your eobs, the penalties increase from 1-5% over the next few years under obama care.

You want to confuse the issue, but it is clear cut, there were not penalties prior to 2009 or mandates. Hell there were never penalties in this history of this country until obamacare. In 2014 there will be further patient penalties....

As for your politics, you are a progressive liberal loser. I am a registered independent and a former democrat for my entire life. The difference between us is that I am successful, spiritual person, and a business owner. you are a loser that needs to justify his existence on a pain forum.... have fun watching your Rachel Maddow every evening sport.

finally, i ran this by my billing company, who represents an entire gamut of physicians(ie peds,pcp, etc). They NEVER submitted a g code, e prescribing code, or quality measure code for any practice priro to the obama administration... I guess we are all delusions but the great Ducttape...

 

[Ducttape]

whatever.

if you have to resort to name calling, you sir have lost the argument.


good luck on that spiritual thing, btw.

 

[Pain Applicant1]

Ducttape:

As for your politics, you are a progressive liberal loser

you are a loser that needs to justify his existence on a pain forum....

I don't think those statements are true and I'm not really sure what the latter means

 

[stim4u]

Sport, I believe you began with the sarcasm. "or land you a job on some conservative talk show".
Statements are all true, consult a biller, look at your superbills. Or even better dont listen and continue the support a faltering CMS system.
thanks for your concern about my spirituality, typically liberal aetheists don't concern themselves about these insignificant things...

 

[lonelobo]

Sport, I believe you began with the sarcasm. "or land you a job on some conservative talk show".
Statements are all true, consult a biller, look at your superbills. Or even better dont listen and continue the support a faltering CMS system.
thanks for your concern about my spirituality, typically liberal aetheists don't concern themselves about these insignificant things...[/QUOTe

Angry white man= Obama is Satan

 

[stim4u]

I am not white. but nice try with the racism ticket. Obama-ites love that tactic.

maybe you and ducttape can get a room together at the next Obama campaign tour.

I can supply the lube.

 

[SSdoc33]

I am not white. but nice try with the racism ticket. Obama-ites love that tactic.

maybe you and ducttape can get a room together at the next Obama campaign tour.

I can supply the lube.

is racism any worse than homophobia? and ill bring the lube, i have plenty.


btw, once a president has been elected twice, he can't be elected again. not sure barack is gonna have another campaign tour. thats the 22nd amendment. i can post a link if you like.


your posts about billing and your medical opinions are invaluable. please keep them coming. the rest of the angry nonsense? not so much

 

[Pain Applicant1]

So, has anyone figured out which PQRS measures they're gonna use?

 

[Mr FancyPants]

I am not white. but nice try with the racism ticket. Obama-ites love that tactic.
maybe you and ducttape can get a room together at the next Obama campaign tour.

You may not be white, liberal, conservative or whatever, but you sure are a d*ck.

Isn't there a moderator around that keeps things on topic here?

 

[stim4u]

Soc doc it is a figure of speach. if you watch the media or read OP ED opinions, obama is criticized for being on a indefinate 'campaign tour'. Typically you can keep up on current topics on realclearpolitics.com if you like.

I am not white, not conservative, and definately not homophobic. My best buddy is gay, and I would imagine i have been to many more gay clubs than most of the haters on this board.

IN response to Pain applicant's question, use these G codes to avoid a CMS penalties and receive a minimal 1% incentive: G8493, and G8502. You should have been using these codes for the last year at least (but never before 2009!!)

Finally, MR. Fancy Pants, since i am a d*ck feel free to blow me....

 

[Pain Applicant1]

IN response to Pain applicant's question, use these G codes to avoid a CMS penalties and receive a minimal 1% incentive: G8493, and G8502. You should have been using these codes for the last year at least (but never before 2009!!)

Thanks! Don't you need to report 3 measures and not 2? I know I should have been reporting for the past year but there's only so much time in the day and I just got around to it - lame excuse. I hope I can get caught up. I just increased my pts/day so now f/u = 10 min and new pts = 20 min so that might help. I hate PQRS 😡

 

[Pain Applicant1]

For G8493 do you need to report >50% of Medicare eligibles or for only twenty patients?

 

[Pain Applicant1]

I'm still not sure how to report this, group vs individual reporting, etc. This is so frustrating. I've read countless articles on this and it still makes little sense to me. It's been months. Would anyone out there who understands this let me call them to discuss this or if anonymity is preferred be willing to call me with a blocked number to help me out? Help please, I'm desperate.

I'm currently holding all of my claims for Medicare and can't continue to hold them until the ASIPP course. Unfortunately, it's difficult for me to survive without my Medicare payments.

 

[stim4u]

You can use these measures (ie g codes) if you meet the clinical documentation criteria. You need to review the pages of history/red flag/education and other clinical data in your notes. your templates should be adjusted to meet these critreria for all NEW patients.
I submit over 20pts NEW patients per year and meet my quota adn avoid my CMS penalty (maybe I get 1% incentive, but have never seen it to date!!!). You can use the alternative method of >50% CMS patients criteria, but that gets confusing to me. and i dont know my cms percentages anymore, as we are more restrictive now.

SO to summarize, fix your templates, meet the documentation criteria for both codes, report over 20 NEW patients, and also remember to report 15 eprescribing patients as well.... hope that helps.

You need a new biller to help you. or more improtantly vote the democrates out of office to avoid this bull****...

 

[Pain Applicant1]

Okay I figured out the whole thing...... I think. The Medicare manual is terribly confusing but I called the CMS dept that handles PQRS and they were surprisingly helpful. Their number is (866) 288 8912.

For us, I think the best way to go is to report G8493 one time only. This lets CMS know that you plan to report the group measures for low back pain. Then, you take 20 new and unique low back pain pts with Medicare and document the necessary information attached. Report G8502 with each of these measures and document correctly. You should avoid the penalty and even possible receive an incentive. I think that's all there is to it. G8502 is the composite code so you shouldn't need to submit the other individual codes if all requirements are met.

Let me know if anyone finds out anything different.

Also bill 0.01 cent for these codes to prevent them from not being recorded.

 

[Pain Applicant1]

You need a new biller to help you. or more improtantly vote the democrates out of office to avoid this bull****...

Thanks for taking the time to answer. I actually literally do my own billing now and my collections have gone up. No offense to anyone but I find all billers suck. I've been through a few of them and had to let them go. Now I'm training my trusted staff to do the billing. I don't think a biller is going to go after a $100 claim if he/she makes only 5 bucks off of it. If it gets rejected why would she spend her time. If that's 20 claims, that's 2K for me only $100 for her and it simply is not worth the time to her. They tend to go only after the low hanging fruit.

 

[Doctodd]

You may not be white, liberal, conservative or whatever, but you sure are a d*ck.

Isn't there a moderator around that keeps things on topic here?

Really? You need a moderator? How bout I get you a tissue....or how bout you just ignore like most adults

 

[powermd]

Does anyone know what constitutes a measures group?

ie is it adequate to just do #148 (has 5 subheadings), or do we have to do 148-150??

We're scrambling to set this up. You need to use a registry for reporting ($$) if you didn't start at the beginning of the year (you could report the codes just on claims if you did). We confirmed that with the CMS helpdesk.

 

[powermd]

The more I read, the more it sounds like you have to do at least 3 items among groups 148-151... err.. 148 is the most onerous in terms of data entry.

 

[Pain Applicant1]

Just refer to my above post. The composite code should take care of everything as it includes multiple measures. Just make sure you document all measures. Also, you can call CMS with any questions at the number I listed above. They're actually very helpful.

 

[Pain Applicant1]

Really? You have to report to a registry? That's gonna be a pain.

The multidimensional pain inventory questionnaire should take care of most of those requirements. Just have all Medicare pts with cc of low back pain fill it out. That's what I'm doing.

 

[Ducttape]

this situation is the one of the few that i can think of where working in a hospital system is beneficial.

the hospital system itself is ensuring that all the criteria for PQRS will be fulfilled. at the moment, i donthave to do a thing.

 

[clubdeac]

ok for this meaningful use crap... do we need to document something before each procedure. My office is getting vitals, height, weight and medication reconciliation and I have been told by my practice manager that this is required to meet meaningful use?!?! Does this pertain to procedures?? It's totally slowing up the check-in process. Does anyone know anything about this

 

[stim4u]

I wish we were all hospital monkeys....

As for the real world pain MD's out there, consider opting out of medicare by 2016. There are non-assignment options which can make you 15% more off medicare, or just opt out period, and charge your patients the traditional MC fee and have them submit fees themselves. This is our model. I believe the data you are transmitting will only penalize you in the future, and is a lawyers wet dream. good luck private guys. Hospital monkeys continue to succumb to Obamacare BS...

 

[Pain Applicant1]

ok for this meaningful use crap... do we need to document something before each procedure. My office is getting vitals, height, weight and medication reconciliation and I have been told by my practice manager that this is required to meet meaningful use?!?! Does this pertain to procedures?? It's totally slowing up the check-in process. Does anyone know anything about this

Med rec, maintaining a medication list, and recording of vital signs are all measures of meaningful use. Whether or not it is required for procedures is based on how your EHR records data. You need to fulfill a certain percentage of however it records its data. The required percentage varies per measure.

 

[bedrock]

I wish we were all hospital monkeys....

As for the real world pain MD's out there, consider opting out of medicare by 2016. There are non-assignment options which can make you 15% more off medicare, or just opt out period, and charge your patients the traditional MC fee and have them submit fees themselves. This is our model. I believe the data you are transmitting will only penalize you in the future, and is a lawyers wet dream. good luck private guys. Hospital monkeys continue to succumb to Obamacare BS...

Interesting.

So you just charge them a bill and say here is the medicare website, go submit the fee?
That would really confuse most of my 75 yr old lady's on medicare who can't even use a computer.

How does the "non-assignment option" make you an extra 15%? By no billing charges?

I would love to escape medicare, and I"m open to anything that will fly, but 35% of my patients are medicare or medicare advantage plan of some kind.

 

[hyperalgesia]

This is a really dumb question but anyway:
If you submit a Mcare claim and the pt has not paid their $147 deductible for the year, will Mcare deny the claim and you're supposed to go bill the pt now? I've never heard of a claim being denied for this reason but I'm not in PP...

If that's the case, and it's also a criminal offense to charge the pt a deductible if they've already paid it, that makes accepting Medicare an even bigger PITA than I thought...

How can you check on the Medicare deductible status of a pt?

 

[Pain Applicant1]

This is a really dumb question but anyway:
If you submit a Mcare claim and the pt has not paid their $147 deductible for the year, will Mcare deny the claim and you're supposed to go bill the pt now? I've never heard of a claim being denied for this reason but I'm not in PP...

If that's the case, and it's also a criminal offense to charge the pt a deductible if they've already paid it, that makes accepting Medicare an even bigger PITA than I thought...

How can you check on the Medicare deductible status of a pt?

All information will be on the EOB. If you don't know what an EOB is or you're not planning on going into PP, you probably don't want to waste your time getting to know this.

 

[hyperalgesia]

All information will be on the EOB. If you don't know what an EOB is or you're not planning on going into PP, you probably don't want to waste your time getting to know this.

So, just to be sure, you rely on the pt providing you with their latest MSN/EOB, just like you would with an insured pt? And, you would expect your claim to be denied if the pt had not paid their yearly deductible?

 

[nvrsumr]

I was in a practice before that was nonparticipating in Medicare. It really confused the patients. I'd love to do it in my own practice but think id lose a lot if patients.

 

[stim4u]

Bedrock:

I am currently working on this model based on information provided by me by other MD from other specialties.

You can bill a medicare patient to a "fee limit of 115% of 95% of the MC schedule". Confusing.
That is, you take home $10 extra for every $100 you bill medicare.
Lots of the neurosurgeons do this for their spinal surgeries and make the extra 10%.

The issue, is that the check goes to the patient.... They are supposed to bring it to you.
I would submit, by 2016, you become non-assignment eligible physician, charge your patients the $300 up front for an epidural/visit, etc. and have the patient know a check from medicare will arrive. You will lose medicare patients, but you will retain good patients that a legit and want more directed care...Plus they don't lose money, the payback is only deferred. Actually, they lose the extra 10% if you bill them the 115% of 95% of the fee schedule.

The additional issues would be collecting the 20% from the secondary medicare insurer, and whether this is seamless like an 'assigned Medicare' physician (most of us currently). Again, I am working on this for the next few years. Just wanted to give a heads up to those solo doctors trying to make it work in the future. I am lucky that medicare only constitutes 20-40% of my income, and maybe less this year (<20% I hope). I have more WC, PI, and commercial insurances but medicare patients still take up close to 30-40% of my time. don't get me wrong I loved medicare patients initially, but now it is not sustainable to allow my panel to be wide open.