Optometry Coding & Billing Alert

Published on Mon Oct 27, 2008 PDF

Hint: Your vendor is interested in helping you maximize your return.

If you were one of the PQRI participants who scoffed at your $600 check, don't lose heart. You may have more of a bonus waiting for you around the bend.

The average individual incentive amount for the 2007 reporting period was approximately $630, while the average incentive payment to a group practice was about $4,700, according to a July 15 CMS press release.

"That's less than minimum wage for all of the work that my staff members put into PQRI," says solo practitioner Neil Verma in Chicago. "We are still going to participate this year, in the hopes that the setup work and everything that we did last year will not have to be repeated and will streamline the process."

Here are three ways that you can make PQRI more valuable, both from a bonus incentive standpoint and from the perspective of improving clinical outcomes.

CMS offers several tools that can help you capture the maximum number of PQRI dollars. For instance, the agency provides PQRI data collection worksheets for certain measures that give you a step-by-step walkthrough to ensure that you've identified the appropriate patients for the measure and captured the right information, so you'll be eligible for the applicable PQRI incentives.

You'll also find that CMS has additional tools on its Web site, such as a participation decision tree and several MLN Matters articles, all available at http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp.

CMS approved 16 PQRI vendors to work with physician practices, and you should look for the one that's the best fit with your practice. Some vendors will offer you the opportunity to interface your PQRI tracking software with multiple carriers, while others will keep your patient records organized according to the measures that you report.

For example: Physician-owned vendor Patient360 offers an educational curriculum that works with PQRI to educate patients on how to manage their diseases.

"We can walk into a practice and identify chronic patients, such as those with COPD or diabetes, and educate the patient using a group model visit, says Douglas J. Jorgensen, DO, CPC, president of Patient360 and a practicing physician in Manchester, Maine. "With our system, the patient gets his or her own portal and the doctor gets one as well."

"Our responsibility is to work as optimally as we can within the boundaries of what the rules are to make sure folks are being reimbursed as much as they can be," Jorgensen says. "Physicians' payments have been going down, and on top of that, the baby boomers are beginning to be consumptive of the very scarce Medicare dollars. Our educational piece will ensure that they're compliant and has been proven to decrease unnecessary medical interventions."

"The 1.5 percent bonus is so small that some practices may not go out of their way to participate, but if we can help optimize participation, it could ultimately bring down healthcare costs across the country," Jorgensen says.

Several specialty societies, both local and national, offer PQRI tools and advice. Contact your association for specialty-specific information on how you can maximize your PQRI participation.