Oncology & Hematology Coding Alert

1 pointer helps you meet the requirements for the 1.5 percent boost  You-ve heard the hubbub about the oncology demonstration project becoming part of CMS- larger Physician Quality Reporting Initiative (PQRI), which means learning a whole new set of rules. Ease the process with these tips for making sure you get the information you need for proper coding.

The basics: PQRI is voluntary and provides a lump-sum bonus of 1.5 percent of the Medicare fee schedule allowed charges for services provided during the July 1 to Dec. 31 reporting period. You don't have to register for the program, which begins July 1.

You choose which quality measures you-re going to start reporting, and just start reporting them. Important: If only three quality measures apply to a service, you must report the measure in at least 80 percent of the cases where it's reportable. When four or more measures apply, you must meet the 80 percent threshold for at least three of the reported measures. Create a PQRI System Now  This program is going to be difficult to implement, says Barbara McAneny, MD, with New Mexico Oncology in Albuquerque. But reimbursement cuts make another 1.5 percent in reimbursement hard to pass up.

What to do: Work on communication between your clinical staff and your administrative people to report measures correctly, CMS officials say.

Step 1: Identify which patients and visits qualify for the quality reporting. You can find the measures and specifications at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp. Keep alert for updates concerning which measures apply to which specialty.

Step 2: Your physician must document in the medical record whether she followed a particular quality guideline. CMS won't tell you how or where this documentation should appear. You could use a checkbox or an area on your encounter form.

Step 3: Translate that quality information over to your claims submission process, so you can submit the correct code, stating whether the physician followed the quality guideline. (Whether the answer is yes or no, you get credit for reporting.)

The biggest hurdle will be prodding software vendors to update systems to handle this program, McAneny says.

Example: Many billing systems won't allow you to report a code with a $0 amount.

Tip: Start early. You can start reporting quality measures any time after July 1. But CMS will judge whether you reported quality measures for 80 percent of your claims based on a July 1 start date. So the later you start, the less your chances of getting the bonus.

More details: CMS will keep updated instructions on the Web at www.cms.hhs.gov/PQRI/. And stay in touch with local Medicare contractors because they should be able to provide you with detailed information.