Part B Insider (Multispecialty) Coding Alert

Published on Sat Feb 17, 2007 PDF

Doctors question whether 1.5-percent bonus is worth extra work

The July 1 deadline to start reporting on quality measures for Medicare is roaring closer--but many providers may get out of the that juggernaut.

The Physician Quality Reporting Initiative (PQRI) will pay your practice an extra 1.5 percent of Medicare payments from July to December. In return, you have to report on up to three applicable quality measures for each visit, using -G- codes and Level II codes.

But the 1.5-percent bonus will cover only approximately 10 percent of this program's costs, calculates Easton, CT physician Stephen Levinson, author of the American Medical Association-s Practical EM: Documentation and Coding Solutions for Quality Health Care. If a typical physician receives an extra $1,500 for all this work, this translates to 75 cents an hour.

-How many coders can you hire for 75 cents per hour to do the extra work?- Levinson asks.

-For quality care, every visit requires active physician analysis and decision-making,- with active documentation, Levinson concludes. -If you are going to load documentation and coding and modifiers for each exception to the [quality] guidelines on top of that, you have a significant administrative cost.-

So how can you make the process of coding for the quality demo as painless as possible? There's no easy clear-cut answer yet, says Collette Shrader, compliance and education coordinator with Wenatchee Valley Medical Center in Wenatchee, WA.

In Shrader's organization, the physicians do their own coding, and then coders match diagnosis codes to procedures and check for Correct Coding Initiative edits.

So the providers will have to add the quality-measure codes to visits, Shrader explains. -We are trying to come up with some way the practitioner can easily do this or we can pull the information from the medical record for him or her.-

Start now: One way to prepare for the PQRI expense is to educate your staff on the importance of -accurate and complete ICD-9 coding,- says Shrader. Getting ICD-9 codes right is important at any time, but it's especially important for the PQRI.