Part B Insider (Multispecialty) Coding Alert

Published on Wed Oct 10, 2007 PDF

California doctors still out of luck with geographic adjusters

If you stayed away from the Physicians Quality Reporting Initiative (PQRI) this year because it didn't have enough measures that applied to you, then 2008 could be your year to dive in.

Next year's PQRI project will have 119 measures, up from 74 in this year's version. The Centers for Medicare & Medicaid Services (CMS) broadened the demo to in-clude some providers who didn't have much opportunity to participate this year, officials said in the Nov. 6 physician Open Door Forum.

The 2008 PQRI also will include two -structural measures-: One will assess your use of electronic prescribing and the other will deal with electronic health records.
CMS set aside $1.35 billion for PQRI bonuses in 2008. But you won't know how high your individual 2008 bonus will be until CMS sees how many practices participate successfully, and then divides the money among them. There may not be any PQRI in 2009, unless Congress extends it, officials noted.

CMS officials also discussed other changes in the 2008 fee schedule regulation:

- CMS failed to find a way to fix the broken system of geographic adjusters for physician payments. California doctors have complained that a Santa Cruz practice receives far lower payments than practices in nearby areas. CMS had suggested three different options to remedy the situation, but the California Medical Association failed to endorse any of them. So CMS decided to leave the situation unchanged and is considering a national fix.

- Doctors now have more leeway as to how often they have to recertify therapy services, as long as they recertify within 90 days after the first cert.

- You-ll have longer to file claims in the Competitive Acquisition Program (CAP) for Part B drugs: 30 days instead of 14 days. And opting out of the CAP program within 60 days if the CAP -imposes a burden- on your practice will be easier. You can also opt out after 60 days if there's an -unanticipated change in circumstances.-

- CMS is adding neuropsychological exam code 96116 to the list of services which it will cover when your physician provides them remotely via video or other telehealth setup.

- CMS is also sticking to its controversial assumption that you use medical equipment in your office about 50 percent of the time. The higher the percentage of time CMS assumes, the lower your expense payments for equipment. So some practices argued in favor of decreasing the number, but CMS refused.