PQRI – Simplifying Physician Bonus Receipt

Welcome to your next issue of the Sage Software eBrief, an update on the latest news, product developments, and tips for bringing your practice into the future with healthcare software. In this issue, you'll find out how the Centers for Medicare & Medicaid's (CMS) Physician Quality Reporting Initiative (PQRI), a pay-for-performance (P4P) initiative that is scheduled for implementation in July, 2007, may affect your practice.

Pay-for-Performance on a National Scale
According to a recent article in the New York Times, "Doctors had been fearing a pay cut under Medicare, the health care program for about 43 million elderly and disabled, but Congress has instead offered a small bonus." *The bonus is part of PQRI, a program established by the Tax Relief and Health Care Act of 2006 to offer incentives to medical practices for attaining specific care-quality goals when treating Medicare patients.

Practices could start participating in PQRI on July 1, 2007. Involvement is completely voluntary for those providers who treat patients covered by Medicare (the program does not cover Medicaid). To participate, eligible practices just begin PQRI reporting with claims for dates of service from July 1, continuing through December 31, 2007. You do not need to register, sign up, or file an intent to participate. The incentive can be up to 1.5% of total allowed charges for covered Medicare physician fee schedule services. For example, up to $3,000 bonus on $200,000 of Medicare billings.

How does PQRI affect Billing?
PQRI affects billing because the appropriate quality measure data will be submitted to Medicare on your claims. Additionally, certain thresholds must be met in order to qualify for the bonuses. So it's important to understand what to report and that you should report appropriate quality measure data on every Medicare claim. For claims submitted on the CMS-1500 Form, procedure codes are reported in field 24D. Whether submitting electronic or paper claims, complete all the necessary data elements (or fields) on the billing line item. Necessary data elements (or fields) include, but are not necessarily limited to, the following:

  • Date of service
  • Place of service
  • PQRI quality-data code, along with modifier (if appropriate)
  • Diagnosis pointer
  • Submitted charge ($0.00 should be entered for PQRI codes)
  • Rendering provider number

To become more familiar with the requirements, especially the quality measures associated with various services, visit the CMS website.

Sage Software Can Help
Sage Software's products help you achieve increased ROI through not only P4P bonuses, but increased efficiencies throughout your practice. The products, which include Intergy EHR by Sage and Practice Analytics by Sage, enable you to gain a complete view of your entire practice. Specific to PQRI, these products allow you to analyze clinical information such as lab tests, specific types of treatments, and more.

Our customers confirm that this information simplifies data analysis and tracking and expedites reimbursement—benefits that have made a substantial impact on practices like Metabolism Associates.

"I can't imagine trying to comb through reams of patient information stored in paper charts, which would make the reimbursement process substantially slower," said David Simon, M.D., of Metabolism Associates. "Using products from Sage Software will allow us to expedite information to CMS, enhancing the chances of us receiving pay-for-performance reimbursement more quickly."

Your Sales Representative can provide a comprehensive on-site demonstration of the Intergy suite of products, including Intergy EHR, or you can view an online demonstration of Intergy EHR now.

To learn more about how Intergy by Sage can support and transform the way you work please:

Ready to Get Started?
The new Physician's Guide to Implementing the Medicare Quality Reporting Initiative by Ingenix provides the information and tools you need to report quality measures to Medicare. Simply complete the attached order form and fax to 508.850.5135 to order this guide from SOLION today.

Best regards,
Sage Software

*Excerpted from Medicare, in a Different Tack, Links Doctors' Pay to Practices by Robert Pear, New York Times, December 12, 2006.