Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 25, 2013 PDF

Plus: Add SMRC to the RACs and other audit organizations.

If you still haven’t gotten on the PQRS train, now’s the time to start collecting bonuses. That’s the word from a recent how-to email that CMS sent to providers last week outlining how to get started with the Physician Quality Reporting System (PQRS).

You must first confirm that you are an eligible professional who provides services paid under the Medicare Physician Fee Schedule—if so, those services are eligible for PQRS incentive payments, the agency notes.

Secondly, you’ll select the appropriate reporting method that applies to you: Either registry reporting, claims reporting, EHR reporting, or via a qualified PQRS EHR data submission vendor. You’ll then choose at least three individual measures or one measures group to report to CMS and submit them by the first quarter of 2014 for this year’s bonuses.

For more on how to participate in the PQRS program, visit www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.

In other news…

If you’re confused about another Medicare contractor that has joined the alphabet soup of organizations that can conduct medical review of your claims, CMS is clearing it up.

CMS contracts with StrategicHealthSolutions to be a Supplemental Medical Review/Specialty Contractor (SMRC), the agency says in a Sept. 30 post on its website. The SMRC conducts nationwide medical review at CMS’s direction to “evaluate medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices,” CMS says.

Targets: Claims may be chosen for review based on “vulnerabilities identified by CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and Federal oversight agencies,” CMS continues.

The SMRC will notify CMS “of any identified improper payments and noncompliance with documentation requests,” the agency explains. Then “the Medicare Administrative Contractor (MAC) may initiate claim adjustments and/or overpayment recoupment actions through the standard overpayment recovery process.”

For more on SMRC audits, visit www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/SMRC.html.