ZirMed, a leading health information connectivity and management solutions company, today revealed the top best practices for maximizing Medicare reimbursements under the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) quality measures and avoid penalties beginning in 2015. ZirMed estimates that eligible providers (EPs) and group practices can gain approximately a total of $3,000 through 2016 by improving PQRS repealing processes.
The Affordable Care Act provides a 0.5 percent incentive payment to EPs and group practices who report on PQRS in 2014. Beginning in 2015, there will be a 1.5 percent penalty—which will increase to two percent beginning in 2016—on all Medicare Part B Physician Fee Schedule (PFS) amounts for covered professional services. EPs can avoid the payment penalty if they report at least one valid measure via claims, a participating registry, or through a qualified EHR, or report one valid measure in a measures group via claims or a participating registry during the 2014 PQRS program year.
ZirMed recommends the following best practices to help providers participate in PQRS successfully:
- Determine which measures are most applicable for your practice. Providers should report on the measures that occur most frequently in their organization so that staff will remember to include PQRS codes on each claim when PQRS reporting becomes part of the organization’s normal workflow.
- Put upfront checks and procedures in place to ensure that PQRS data is included on all claims that require it. Sending a single batch of claims without PQRS data could seriously jeopardize a provider’s chance of qualifying for the bonus as there is no way to add PQRS data to a claim once it has been submitted.
- Prepare proactively for CMS deadlines. CMS just released a new interactive timeline that contains the critical dates and relevant information that providers need to know. This timeline helps providers track upcoming deadlines and flag opportunities for submitting information or requesting informal reviews.
- Discuss PQRS with providers and staff members. PQRS will entail changes in workflow and it is important to ensure that everyone on staff is aware of and prepared for these changes.
“Providers have a tremendous opportunity to earn additional reimbursements now while familiarizing themselves with a program that will become mandatory in 2015,” said Betty Gomez, head of regulatory strategy, ZirMed. “We’ve responded to our clients’ concerns about PQRS with a comprehensive toolkit to help providers follow best practices to successfully participate in the program. Instead of wading through hundreds of pages of documentation produced by CMS, our clients can ask us to do the heavy lifting and avoid penalties in the years ahead.”
ZirMed’s PQRS monitoring services enhances providers’ ability to find and correct claims that lack the necessary PQRS data while simultaneously minimizing workflow disruptions. ZirMed’s PQRS solution provides an analysis of historical claims to help individual providers determine which initiatives you should elect to report for PQRS. Throughout the year, ZirMed scrubs all of the outgoing Medicare Part B claims and alerts providers each time a claim that meets the requirements for the PQRS measures selected lacks the necessary PQRS quality codes.
To learn more about ZirMed’s PQRS solutions, download ZirMed’s PQRS whitepaper or visit ZirMed’s website at http://www.zirmed.com.
Founded in 1999, ZirMed is the nation’s premier health information connectivity and management solutions company, modernizing critical connections between providers, patients, and payers to improve the business and process of healthcare. ZirMed combines innovative software development with the industry’s most advanced transactional network and business analytics platform to give organizations a clearer view of their financial and operational performance. ZirMed’s industry-leading technology and client support have been recognized with awards from KLAS, Healthcare Informatics, Best of SaaS Showplace (BoSS), and Black Book Rankings. Our nationwide network facilitates, manages, and analyzes billions of healthcare transactions, driving bottom-line performance with clinical communications, comprehensive analytics, eligibility, claims management, coding compliance, reimbursement management, and patient payment services—including credit card processing, online payments, statements, estimation, and payment plan management. For more information about ZirMed, visit www.ZirMed.com.