Medicare Compliance & Reimbursement

Money for 2007 bonuses is guaranteed--but 2008 funds aren't

Don't believe the rumors: Some providers who had a perfect record on the Physician Quality Reporting Initiative (PQRI) suddenly stopped reporting the quality codes because they heard that there wouldn't be any money to pay bonuses for 2007, warned CMS officials on a Sept. 26 conference call.

In fact: The Centers for Medicare & Medicaid Services (CMS) will definitely pay bonuses for people who meet the requirements for 2007, and this money will come out of the general Part B fund.

It's true that some Medicare reform legislation in Congress has contained language that would eliminate money for bonuses for 2008, but those bills haven't gone anywhere so far.

Other news from the PQRI conference call:

Interim reports: CMS is working on creating the report that your physicians receive on their participation in
the program.

It's possible that next year, you could be receiving interim reports that would allow you to find out halfway through if your doctor was meeting the PQRI requirements, officials said.

2008 PQRI reporting: Medicare is considering adding a number of measures to the PQRI for 2008, which would broaden the program's participation.

Some new measures have already appeared as Category II HCPCS codes, but don't assume those will be in the program next year, officials cautioned.

Additional channels for reporting: You could have new ways to report measures soon, including electronic health records. Also, many practices already submit data to clinical registries, and CMS could find ways to use this data for the PQRI.