Medicare Jurisdiction E Part B Updates

Payment Rules Notice

Although we are still assessing the impact of the partial government shutdown on completion of the calendar year 2014 Medicare fee for service payment regulations, we intend to issue the final rules on or before November 27, 2013, generally to be effective on January 1, 2014. The impacted regulations include:

• Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (CMS-1526-F)
• CY 2014 Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (CMS-1601-FC)
• CY 2014 Home Health Prospective Payment System Final Rule (CMS-1450-F)
• Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2014 Final Rule with Comment Period (CMS-1600-FC)

Source: LEARNRESOURCE-L E-mail Update, National Institutes of Health, U.S. Department of Health and Human Services dated October 23, 2013

READ MORE - Medicare Jurisdiction E Part B Updates

Medicare/Noridian New Waived Tests - Revised November 2013

New Waived Tests - Revised

MLN Matters® Number: MM8439 Revised
Related Change Request (CR) #: CR 8439
Related CR Release Date: October 28, 2013
Effective Date: January 1, 2014
Related CR Transmittal #: R2804CP
Implementation Date: January 6, 2014

This article was revised on October 29, 2013, to reflect a new Change Request (CR). The CR corrects the spelling of "Premier Integrity Solutions P/Tox Drug Screen Cup." The transmittal number, CR release date and web link to the transmittal was also changed. All other information remains the same.

Provider Types Affected
This MLN Matters® Article is intended for clinical diagnostic laboratories submitting claims to Medicare Claims Administration Contractors (Medicare Contractors) for services to Medicare beneficiaries.

Provider Action Needed
If you do not have a valid, current, Clinical Laboratory Improvement Amendments of 1998 (CLIA) certificate and submit a claim to your Medicare Carrier or A/B MAC for a Current Procedural Terminology (CPT) code that is considered to be a laboratory test requiring a CLIA certificate, your Medicare payment may be impacted.
CLIA requires that for each test it performs, a laboratory facility must be appropriately certified. The CPT codes that the Centers for Medicare & Medicaid Services (CMS) consider to be laboratory tests under CLIA (and thus requiring certification) change each year. Change Request (CR) 8439, from which this article is taken, informs carriers and MACs about the latest new CPT codes that are subject to CLIA edits.
Make sure that your billing staffs are aware of these CLIA-related changes for 2014 and that you remain current with certification requirements.

Background
Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA. The Current Procedural Terminology (CPT) codes for the following new tests must have the modifier QW to be recognized as a waived test. However, the tests mentioned on the first page of the list attached to CR8439 (i.e., CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651) do not require a QW modifier to be recognized as a waived test.
The CPT code, effective date and description for the latest tests approved by the FDA as waived tests under CLIA are the following: 

• G0434QW, January 23, 2008, Phamatech At Home 12 Drug Test (Model 9308T); 
• G0434QW, January 23, 2008, Phamatech At Home 12 Drug Test (Model 9308Z); 
• 81003QW, January 29, 2013, Henry Schein Urispec Plus Urine Analyzer;  
• G0434QW, February 27, 2013, CLIA waived, Inc. Rapid Drug Test Cup; 
• G0434QW, February 27, 2013, Clinical Reference Laboratory, Inc. Intelligent Transport Cup; 
• G0434QW, February 27, 2013, Noble Medical Inc. Noble 1 Step Cup; 
• G0434QW, February 27, 2013, Premier Integrity Solutions P/Tox Drug Screen Cup; 
• G0434QW, February 27, 2013, US Diagnostics ProScreen Drugs of Abuse Cup; 
• 84443QW, March 5, 2013, BTNX Rapid Response Thyroid Stimulating Hormone (TSH) Test Cassette (Whole Blood); 
• 86308QW, March 11, 2013, Henry Schein OneStep Pro+ Mono {Whole Blood}; 
• G0434QW, May 15, 2013, UCP Biosciences, Inc. UCP Home Drug Screening Test Cups; 
• G0434QW, May 17, 2013, Alere Toxicology Services, Inc. Tox Screen Drugs of Abuse Test Cup; 
• G0434QW, June 24, 2013, Advin Multi-Drug Screen Test; and 
• 87880QW, July 3, 2013, Henry Schein OneStep Pro+ Strep A Cassette.

Additional Information
The official instruction, CR8439, issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2804CP.pdf  on the CMS website.  

Last Updated Nov 04, 2013

READ MORE - Medicare/Noridian New Waived Tests - Revised November 2013

Medical Practices: Think Twice Before Waiving Copays

Historically, family practices and many other physicians groups have routinely waived insurance copays as a gesture of goodwill to patients in a tight economy. After all, who wants to hound sick patients for their portion of the charges?

There was a time when insurance companies turned a blind eye to these routine waivers of copays. Not anymore.

The AMA's Code of Medical Ethics Opinion 6.12 explains why routine waivers are unethical, particularly when a clinic advertises a willingness to waive copayments.

Further, the Office of Inspector General (OIG) has long taken the position that routine waiver of copayments constitutes an illegal kickback, which is a felony. 

The routine waiver of copayments also constitutes a violation of the terms of private insurance company plans. This contractual violation serves as a basis for a recoupment audit, during which insurance companies request proof of collection of copayments for five randomly selected patients. If the clinic cannot prove it collected, or at least exhausted all reasonable means of collection, then the carrier may demand a refund for any benefits paid across a large patient population.

Perhaps most frighteningly, routine copay waivers constitute ordinary financial fraud. If a patient is charged $100 and the insurance carrier is billed $80, the patient is supposed to pay $20. If you never attempt to collect the $20, this means the actual charge is $80, not $100.  Therefore, the insurance company should only pay $64 (80 percent of the $80
Fraud or dishonesty is a primary way to get in trouble with state medical boards.

There are provisions for waiving copayments in cases of financial hardship. At a minimum, you should document the financial hardship, and obtain a release from the patient to turn the financial document over to the insurance company, if requested.

The OIG states the following criteria for waiver on the basis of financial hardship:

• The waiver must be based on a good faith determination of the patient’s financial need. In other words, waivers must not be applied routinely. The government does not specify the financial status that would justify a waiver, so you should develop your own approach, apply it consistently, and document your efforts. For example, if your efforts to collect on a patient’s bill fail, or if it’s obvious that a patient is struggling to pay the amount owed, ask the beneficiary to fill out a form noting their employment status and average household income and expenses. Then make your determination based on the information provided.

• The waiver must not be based on the amount of the charges. Your decision about whether to waive what a patient owes should be based on the patient’s ability to pay without regard to what Medicare may have paid or the total charges for the service.

• The waiver must not be offered as part of an advertisement or solicitation.

State laws vary regarding waivers. Therefore, seek the advice of an experienced health lawyer in your state if you have questions about your practices.

Article By Martin Merritt from Physicians Practice
http://www.physicianspractice.com/blog/medical-practices-think-twice-before-waiving-copays?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

READ MORE - Medical Practices: Think Twice Before Waiving Copays

2014 Medicare Physicians Fee Schedule (MPFS) Available Soon

2014 MPFS Available Soon Watch for the 2014 Medicare Physician Fee Schedule (MPFS). It will be published on the “Fee Schedules” webpage at med.noridianmedicare.com/web/jeb/fees-news/fee-schedules after its regulation is put on display.
Last Updated Nov 27, 2013

READ MORE - 2014 Medicare Physicians Fee Schedule (MPFS) Available Soon

Physicians Dropped by Health Plans for Overutilization

By Averel B. Snyder, MD from Physicians Practice

After United Healthcare dropped 15 percent of its provider panel, I was not surprised. I actually thought something like that would occur sooner. It is clear that for Medicare to survive and to decrease healthcare costs in this country, healthcare delivery needs to change. Most believe that fee-for-service reimbursement is no longer an option and there seems to be a shift toward pay for performance. Clearly, increasing quality, decreasing costs, and increasing patient satisfaction are goals both payer and provider would strive for.

There are certain services in place to help meet these goals. One such example is the Medicare Annual Wellness Visit (AWV). The AWV, by delivering evidence-based preventive services, helps keep patients healthier and prevents over-utilization of services. The visit also helps satisfy quality measures for PQRS reporting. Despite all these advantages only approximately 12 percent of Medicare beneficiaries have had their AWV.

Another way to increase quality and decrease costs is to identify those patients that are at increased risk of overutilization. The current methodology to identify risk is the CMS HCC method. In addition to identifying risk by assigning a risk score to each patient, the codes are necessary for Medicare Advantage (MA) plans to get paid from CMS. The majority of physicians do an incomplete job of coding, making it necessary for MA plans to use third-party providers for risk assessments and retrospective chart reviews. There are now automated software solutions that provide all the components of the AWV and calculate the CMS HCC risk score real time.

The point is that fee-for-service overutilization, no coding, and not providing quality measures will not be and should not be tolerated. Those plans with strong executive leadership will identify those top 15 percent physician over-utilizers and not allow them to participate in the MA plan. If I was one of those executives I would make the same decision. It is time to make the paradigm shift and provide the highest quality care as cost efficiently as possible. It is to the providers' advantage to provide wellness visits for all their Medicare patients, and to understand the nuances of HCC coding.

Article By Averel B. Snyder, MD from Physicians Practice

http://www.physicianspractice.com/blog/physicians-dropped-health-plans-overutilization?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

READ MORE - Physicians Dropped by Health Plans for Overutilization

Improve Your Patients’ Health with the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) Medicare Part B/Noridian

MLN Matters® Number: SE1338
Related Change Request (CR) #: NA
Related CR Release Date: NA
Related CR Transmittal #: NA
Effective Date: NA
Implementation Date: NA

Provider Types Affected

 All health care professionals who care for Medicare patients.

What You Need to Know

Medicare covers an annual preventive visit for all Medicare patients. These visits are:

• The Initial Preventive Physical Examination (IPPE); and
• The Annual Wellness Visit (AWV).

These examinations allow you to assess your patients' health on an annual basis to help you determine if they have any risk factors and if they are eligible for other preventive services and screenings that Medicare covers.

These examinations are a great way for you to detect illnesses in their earliest stages when treatment works best. The average reimbursement level for the AWV is about $107 and about $150 for the IPPE with no patient deductible or co-pay. These are cost-effective services as well as a good way to keep in touch with your patients every year.

Note: Please check the physician fee schedule for the exact amount of reimbursement for your locality and setting. You can view the physician fee schedule by visiting http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/index.html  on the Centers for Medicare & Medicaid Services (CMS) website.

The Initial Preventative Physical Exam IPPE (Welcome to Medicare physical)
Medicare covers an IPPE for all patients who have newly enrolled in Medicare Part B.

• The patient must receive this service within the first 12 months after the effective date of their Medicare Part B coverage.
• The IPPE is a one-time benefit.
• There are 7 components in every IPPE:
  • Review the patient's medical and social history;
  • Review potential risk factors for depression and other mood disorders;
  • Review functional ability and level of safety;
  • An examination of the patient;
  • End-of-life planning;
  • Education, counseling and referral based on the previous 5 components; and
  • Education, counseling and referral for other preventive services.

For more information about the IPPE, including a more detailed description of the 7 elements, please see "Quick Reference Information: The ABCs of the IPPE" at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf  on the CMS website.

The AWV or Annual Wellness Visit

Medicare covers an annual AWV for patients:

• Who are no longer within 12 months of the effective date of their first Part B coverage period; and
• Who have not gotten either an IPPE or AWV within the previous 12 months.

Medicare pays for only one first AWV. Medicare will pay for a subsequent AWV for each patient annually. Note: The elements in first and subsequent AWVs, and the codes to bill them, are different.

• There are 6 elements in a first AWV:
  • An assessment;
  • Establishment of a current list of provider and suppliers;
  • Detection of cognitive impairment the patient may have;
  • Establishment of a written screening schedule;
  • Establishment of a list of risk factors; and
  • Providing personalized health advice and referral to appropriate health education or other preventive services.
• There are 8 elements in a subsequent AWV:
  • Update health risk assessment;
  • Update medical and family history;
  • Assessment;
  • Update of list of current providers and suppliers;
  • Detection of cognitive impairment the patient may have;
  • Update of the written screening schedule;
  • Update of the list of risk factors; and
  • Provision of personalized health advice and referral to appropriate health education or other preventive services.

As long as a physician is providing supervision, appropriately trained members of your office staff can provide the components of the AWV.
For more information about the AWV, including a more detailed description of the elements of the AWV, please see

• "Quick Reference Information: The ABCs of the AWV" at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf  or
• "Providing the Annual Wellness Visit" at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AnnualWellnessVisit-ICN907786.pdf  on the CMS website.

Additional Information

The Medicare Learning Network® has published a variety of additional educational material on Medicare-covered Preventive Services, including:

• Preventive Services Educational Products: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/education_products_prevserv.pdf;
• The Preventive Services MLN page: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html;  and
• MLN Matters® Articles Related to Medicare-Covered Preventive Benefits http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MLNPrevArticles.pdf.

For general information about Medicare-covered preventive services, visit the CMS Prevention page at http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html  on the CMS website. For information to share with your Medicare patients, please visit http://www.medicare.gov  on the Internet.

Last Updated Nov 18, 2013

READ MORE - Improve Your Patients’ Health with the Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) Medicare Part B/Noridian

Update to Medicare Deductible, Coinsurance, and Premium Rates for 2014

MLN Matters® Number: MM8527
Related Change Request (CR) #: CR 8527
Related CR Release Date: November 15, 2013
Related CR Transmittal #: R82GI
Effective Date: January 1, 2014
Implementation Date: January 6, 2014

Provider Types AffectedThis MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims to Medicare contractors (Fiscal Intermediaries (FIs), carriers, Regional Home Health Intermediaries (RHHIs), Durable Medical Equipment/ Medicare Administrative Contractors (DME/MACs) and A/B Medicare Administrative Contractors (A/B MACs)) for services to Medicare beneficiaries.

Provider Action NeededThis article is based on Change Request (CR) 8527 which details the new Calendar Year (CY) 2014 Medicare premium, coinsurance, and deductible amounts. Make sure that your billing staffs are aware of these changes.

BackgroundBeneficiaries who use covered Part A services may be subject to deductible and coinsurance requirements. A beneficiary is responsible for an inpatient hospital deductible amount, which is deducted from the amount payable by the Medicare program to the hospital, for inpatient hospital services furnished in a spell of illness. When a beneficiary receives such services for more than 60 days during a spell of illness, he or she is responsible for a coinsurance amount equal to one-fourth of the inpatient hospital deductible per-day for the 61st-90th day spent in the hospital. An individual has 60 lifetime reserve days of coverage, which they may elect to use after the 90th day in a spell of illness. The coinsurance amount for these days is equal to one-half of the inpatient hospital deductible. A beneficiary is responsible for a coinsurance amount equal to one-eighth of the inpatient hospital deductible per day for the 21st through the 100th day of Skilled Nursing Facility (SNF) services furnished during a spell of illness.
Most individuals age 65 and older, and many disabled individuals under age 65, are insured for Health Insurance (HI) benefits without a premium payment. The Social Security Act provides that certain aged and disabled persons who are not insured may voluntarily enroll, but are subject to the payment of a monthly premium. Since 1994, voluntary enrollees may qualify for a reduced premium if they have 30-39 quarters of covered employment. When voluntary enrollment takes place more than 12 months after a person's initial enrollment period, a 10 percent penalty is assessed for 2 years for every year they could have enrolled and failed to enroll in Part A.
Under Part B of the Supplementary Medical Insurance (SMI) program, all enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute. When Part B enrollment takes place more than 12 months after a person's initial enrollment period, there is a permanent 10 percent increase in the premium for each year the beneficiary could have enrolled and failed to enroll.
The updated rates are as follows:

2014 PART A - HOSPITAL INSURANCE (HI) RATES

Deductible

• $1,216.00

Coinsurance

• $304.00 a day for 61st-90th day
• $608.00 a day for 91st-150th day (lifetime reserve days)
• $152.00 a day for 21st-100th day (Skilled Nursing Facility coinsurance)

Base Premium (BP)

• $426.00 a month

BP with 10% surcharge

• $468.60 a month

BP with 45% reduction

• $234.00 a month (for those who have 30-39 quarters of coverage)

BP with 45% reduction and 10% surcharge

• $257.40 a month

2014 PART B - SUPPLEMENTARY MEDICAL INSURANCE (SMI) RATES

Standard Premium

• $104.90 a month

Deductible

• $147.00 a year

Pro Rata Data Amount

• $114.99 1st month
• $32.01 2nd month

Coinsurance

• 20 percent

Additional InformationThe official instruction, CR 8527 issued to your MAC regarding this change may be viewed at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R82GI.pdf  on the CMS website.

If you have any questions, please contact your MAC at their toll-free number, which may be found at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/provider-compliance-interactive-map/index.html   on the CMS website.

READ MORE - Update to Medicare Deductible, Coinsurance, and Premium Rates for 2014

A little known rule in the ACA could pose financial risk to doctors

A little known rule published by CMS to implement the Affordable Care Act (ACA) could pose a significant financial risk for doctors, hospitals and other healthcare providers. The rule requires health plans participating in the exchanges to provide individuals purchasing insurance through the exchanges a grace period before terminating the coverage for non payment of the premiums. Doctors and other healthcare providers will continue to provide care during the grace period, but the insurance plan will not be required to pay the claims incurred during most of the grace period. The result could be that physicians and other healthcare providers would provide a significant amount of uncompensated care.

Details of the rule

The CMS rule provides individuals that purchase subsidized coverage through the exchanges a 90-day grace period before their coverage is cancelled for non payment. The insurance plan is required to pay any claims incurred during the first 30 days of the grace period, but the insurance plan is not required to pay the claims incurred during the last 60 days of the grace period if the individual’s coverage is terminated. The insurance plan is allowed to place all the claims during the last 60 days of the grace period in a pending status. The rule requires the insurance plan to notify the healthcare providers when an insured individual is in the last 60 days of the grace period.

Risk falls on healthcare professionals and providers

The rule imposes a significant risk for uncompensated care on the healthcare providers. The rule does require insurers to tell healthcare providers when patients are behind on their premium payments, but he rule does not specify how the health plan will provide that notice to the providers. The only notice some providers receive will probably be the pending status placed on the unpaid claims by the insurance plan.
Many doctors and hospitals are reluctant to participate in insurance plans offered on the exchanges due to the increased financial risk associated with the CMS rule. The result could be that individuals enrolling in insurance plans through the exchanges may find it difficult to find a healthcare provider willing to accept them as patients. CMS has been asked to modify the rule so that insurers are required to pay claims during the entire 90-day grace period.

How grace period can be manipulated to benefit patients

The CMS rule may also result in individuals manipulating the system. Some individuals may intentionally pay premiums for only part of the year and become serial abusers of the 90 day grace period. Another unintended consequence of the ACA is that individuals that choose not to pay their premiums and have their coverage terminated can reenter the exchange and enroll in a plan regardless of their pre-existing conditions so there is little incentive for some individuals to maintain their coverage.

Were you aware of the 90-day grace period? As a healthcare professional or provider, are you worried you don’t have adequate financial protection?

Michael L. Smith is an attorney and George F. Indest, III is president and managing partner, both at The Health Law Firm.
Courtesy of: http://www.kevinmd.com/blog/2013/11/rule-aca-pose-financial-risk-doctors.html

READ MORE - A little known rule in the ACA could pose financial risk to doctors

New CMS-1500 Medi-Cal (California Medicaid) Guide for Use Beginning January 6, 2014

Medi-Cal has created a New CMS-1500 Medi-Cal Guide to show providers the fields that have changed on the new 02/12 version of the CMS-1500 claim form. Information submitted in the fields will be the same as information submitted previously on the old 08/05 version of the claim form.

Providers can refer to the CMS-1500 Completion or CMS-1500 Completion for Vision Care section in the appropriate Part 2 provider manual for claim completion instructions by field number. Side-by-side comparisons of the current and upcoming claim fields are available in the New CMS-1500 Medi-Cal Guide, which can be downloaded from the new Claim Form Updates page of the Medi-Cal website.

Old and New Claim Versions: Dates of Use
Beginning January 6, 2014, the Medi-Cal claims processing system will be able to accept and process the new 02/12 version of the CMS-1500. The old 08/05 version of the CMS-1500 will continue to be accepted and processed also, but only for three months, through March 31, 2014. Beginning April 1, 2014, only claims submitted on the 02/12 version will be accepted and processed.

Provider Manual Update Plan
The CMS-1500 claim form has been revised to accommodate the ICD indicator that will be required on claims in 2014 with the ICD-10-CM code rollout. Rather than update the entire provider manual to announce claim updates and then next year release the manual pages again with ICD-10 information, Medi-Cal has determined to approach provider manual updates as follows:

• To serve the immediate need for claim completion instructions, the CMS-1500 Completion and CMS-1500 Completion for Vision Care manual sections will be updated. The sections are slated for release in the December 2013 Medi-Cal Update bulletins. A set of instructions for completing the new 02/12 version of the CMS-1500 will be added at the front of each section. The older 08/05 instructions will be retained at the back of the section.
• Claim field names in the provider manual will continue as they appear on the 08/05 version of the CMS-1500. For example, Reserved for Local Use field (Box 19) will be retained and not changed to Additional Claim Information field (Box 19) until later in 2014.
• Billing examples will be retained, as is, in the 08/05 version of the CMS-1500.
• If it is determined that claim instructions must be updated before ICD-10-related manual pages are released in 2014, an analysis will be performed to decide if select manual pages should be updated and released.

The above cost-saving approach will allow several hundred manual sections to be updated only once.

Courtesy of: http://files.medi-cal.ca.gov/pubsdoco/Claims/Articles/claims_21966.asp?utm_source=iContact&utm_medium=email&utm_campaign=Medi-Cal%20NewsFlash&utm_content=21966

READ MORE - New CMS-1500 Medi-Cal (California Medicaid) Guide for Use Beginning January 6, 2014

New Influenza Virus and Hepatitis B Virus Vaccine Codes: Noridian/Medicare

MLN Matters® Number: MM8249
Related Change Request (CR) #: CR 8249
Related CR Release Date: May 2, 2013
Effective Date: November 20, 2012 (For code 90661); January 1, 2013 (For codes 90653, 90672, 90685, 90686, 90687, 90688, 90739, and Q2033)
Related CR Transmittal #: R2693CP Implementation Date: October 7, 2013

Provider Types Affected
This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), carriers and A/B Medicare Administrative Contractors (MACs)) for services to Medicare beneficiaries.

What You Need to Know
This article is based on Change Request (CR) 8249, which provides instructions for payment and Common Working File (CWF) edits to be updated to include influenza virus vaccine codes 90653, 90672, 90685, 90686, 90687, 90688, and Q2033; and hepatitis B virus vaccine code 90739 for claims with dates of service on or after January 1, 2013, but processed on or after October 7, 2013. The CR also provides instructions for payment and Medicare Common Working File (CWF) edits to be updated to include influenza virus vaccine code 90661 for claims with dates of service on or after November 20, 2012, processed on or after October 7, 2013. Make sure that your billing staffs are aware of these updates.

Background
Vaccines that are described by codes 90653, 90685, 90687, 90688, and 90739 are currently pending Food and Drug Administration (FDA) approval. Vaccines that are described by codes 90661, 90672, 90686, and Q2033 have already been approved.
The Centers for Medicare & Medicaid Services (CMS) will notify Medicare contractors once FDA approval is obtained for the vaccines that are described by codes 90653, 90685, 90687, 90688, and 90739. In addition, Medicare contractors are adding Q2033 as an acceptable influenza vaccine code. As a result of CR8249:

• Effective for claims with dates of service on or after January 1, 2013, vaccine codes 90653, 90672, 90685, 90686, 90687, 90688, 90739, and Q2033 will be payable by Medicare.
• Effective for claims with dates of service on or after November 20, 2012, code 90661 will be payable by Medicare.

Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners and suppliers who administer the influenza virus vaccination must take assignment on the claim for the vaccine.

On professional claims, for dates of service between January 1, 2013 and September 30, 2013, Medicare contractors shall use local pricing guidelines to determine payment rates for influenza virus vaccine codes 90653, 90672, 90685, 90686, 90687, 90688, and Q2033; and hepatitis B virus vaccine code 90739. For dates of service on or after October 1, 2013, Medicare contractors will use Medicare Part B payment limits for these codes. Effective for dates of service between November 20, 2012, and September 30, 2013, contractors shall use local pricing guidelines to determine payment rates for influenza virus vaccine code 90661.

On institutional claims, hospitals (type of bill (TOB) 12X and 13X), skilled nursing facilities (TOB 22X and 23X), home health agencies (TOB 34X), hospital-based renal dialysis facilities (72X), and critical access hospitals (85X), payment will be based on reasonable cost for codes 90653, 90672, 90685, 90686, 90687, 90688, 90739, and Q2033 with dates on service on or after January 1, 2013. For the same facilities billing code 90661 on or after November 20, 2012, the payment is also based on reasonable cost.

For Indian Health Services (IHS) facilities (including IHS critical access hospitals), comprehensive outpatient rehabilitation facilities, and independent renal dialysis facilities, payment will be based on the lower of the actual charge or 95% of the Average Wholesale Price (AWP).
Medicare contractors shall deny claims for vaccines containing codes 90653, 90685, 90687, 90688, and 90739 if vaccines described by these codes have not obtained approval from the FDA by October 1, 2013. In doing so, they will use:

• Claims Adjustment Reason Code (CARC) 114: Procedure/product not approved by the Food and Drug Administration.
• Remittance Advice Remark Code (RARC) M51: Missing/incomplete/invalid procedure code.
• Group Code: CO

Contractors shall also deny claims containing vaccine codes 90653, 90685, 90687, 90688, and 90739 if no product is located as a result of utilizing local pricing guidelines.

Additional Information
The official instruction, CR 8249, issued to your Medicare contractor regarding this change, may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2693CP.pdf  on the CMS website.

Last Updated Nov 07, 2013

Courtesy of: https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10525/new-influenza-virus-and-hepatitis-b-virus-vaccine-codes

READ MORE - New Influenza Virus and Hepatitis B Virus Vaccine Codes: Noridian/Medicare

Back to School: Identify How ICD-10 Will Affect Your Practice

In order to be fully prepared for the October 1, 2014, ICD-10 transition, you need to know exactly how ICD-10 will affect your practice. Although many people associate coding with submitting claims, in reality, ICD codes are used in a variety of processes within clinical practices, from registration and referrals to billing and payment.
The following is a list of important questions to help you think through where you use ICD codes and how ICD-10 will affect your practice. By making a plan to address these areas now, you can make sure your practice is ready for the ICD-10 transition.

• Where do you use ICD-9 codes? Keep a log of everywhere you see and use an ICD-9 code. If the code is on paper, you will need new forms (e.g., patient encounter form, superbill). If the code is entered or displayed in your computer, check with your EHR and/or practice management system vendor to see when your system will be ready for ICD-10 codes.
• Will you be able to submit claims? If you use an electronic system for any or all payers, you need to know if it will be able to accommodate the ICD-10 version of diagnoses and hospital inpatient procedures codes. If your billing system has not been upgraded for the current version of HIPAA claims standards—Version 5010—you will not be able to submit claims. Check with your practice management system or software vendor to make sure your claims are in the HIPAA Version 5010 format and that your system or software can include the ICD-10 version of diagnoses and hospital inpatient procedures codes.
• Will you be able to complete medical records? If you use any type of electronic health record (EHR) system in your office, you need to know if it will capture ICD-10 codes. Look at how you enter ICD-9 codes (e.g., do you type them in or select from a drop down menu) and talk to your EHR vendor about your system’s capabilities for ICD-10. If your EHR system does not capture ICD-10 codes and you use another terminology (SNOMED), you will still need ICD-10 codes to submit claims.
• How will you code your claims under ICD-10? If you currently code by look up in ICD-9 books, purchase the ICD-10 code books in early 2014. Take a look at the codes most commonly used in your office and begin developing a list of comparable ICD-10 codes. Alternatively, check your software for an ICD-10 look up functionality.
• Are there ways to make coding more efficient? For example, develop a list of your most commonly used ICD-9 codes and become familiar with the ICD-10 codes you will use in the future; and invest in a software program that helps small practices with coding.

Want more information about ICD-10?
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates from CMS.

Courtesy of: Centers for Medicare & Medicaid Services (CMS) Weekly Digest Bulletin

READ MORE - Back to School: Identify How ICD-10 Will Affect Your Practice

Part A and Part B Endeavor Contact Information (Medicare/Noridian)

Medicare Updates

• Part A and Part B Endeavor Contact Information
User Security may assist providers with locked accounts, password resets, etc.:
o JE: 855-609-9960
o JF: 877-908-8431
For assistanct with specific claim or eligibility issues, contact Customer Service:
o JE: 855-609-9960
o JF: 877-908-8431

JE states include California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands.
JF states include Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming.
Additional Endeavor Information
Information regarding Endeavor is available on the Noridian website:
o Part A:
 JE: med.noridianmedicare.com/web/jea
 JF: www.noridianmedicare.com/parta/
o Part B:
 JE: med.noridianmedicare.com/web/jeb
 JF: www.noridianmedicare.com/partb/

READ MORE - Part A and Part B Endeavor Contact Information (Medicare/Noridian)

New Measures in Pay-for-Performance Programs

Pay for performance, or P4P as it is more commonly known, is not a new concept and some plans have been using this type of initiative with providers for a decade or more. Those providers that participate in Medicare's Physician Quality Reporting System (PQRS) — which uses a combination of incentive payments and payment adjustments to promote reporting of quality information — as well as those participating in large Blues plans, will be most familiar with this model.

The shift What is new is the shift away from P4P as a "bonus" structure and a shift toward an "earning" structure. That is, the extent to which payers are incorporating P4P into their payment strategies means that a portion (or percentage) of providers' revenue is "earned" through meeting P4P targets or measures.  These new models are referred to as "value-based," shifting away from straight fee-for-service payments to some combination of performance- and fee-based compensation, which puts some of the financial risk on providers. The hope is this type of compensation model will improve the quality of care, reduce medical costs over time, and improve patient outcomes. So you can think of the newer P4P models as Pay for outcomes, or P4O.  Under Medicare  The Affordable Care Act expands P4P efforts in hospitals through the establishment of a Hospital Value-Based Purchasing Program begun last year, where hospitals are rewarded for how well they perform on a set of quality measures, as well as on how much they improve in performance relative to a baseline.  The healthcare law also extends the Medicare PQRS program through 2014. However, beginning in 2015 the incentive payments go away, and physicians who do not satisfactorily report quality data will see their payments from Medicare reduced. This marks the real beginning of P4O, in my view, due to the setting of a "quality care" baseline against which the ability to earn will then be tied.

By commercial payers For commercial payers, value-based contracts are springing up around Patient-Centered Medical Homes (PCMHs) and accountable care organizations (ACOs). However, new and negotiated contracts for generalized services — that is, practices that are not technically a PCMH or ACO — are now typically being crafted with P4P/P4O components that allow practices to "earn" additional dollars or year-to-year increases in multi-year contracts through meeting specific measures and targets.  Theses measure are typically HEDIS-based (Healthcare Effectiveness Data and Information Set) which is a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). Many of these measures are focused on high-cost conditions such as heart disease, diabetes, high blood pressure, as well as preventive measures like immunizations and medication management. New and changed measures for 2014 include breast- and cervical-cancer screenings.

 Commercial payers utilizing P4P measures typically have a combination of HEDIS-type "quality" measures as well as "self-reported" measures, where practices can report on items such as EHR implementation and use, and status in achieving NCQA programs such as Patient-Centered Medical Home (PCMH), diabetes, heart/stroke, and back pain recognition programs. In addition to NCQA measures, there is substantial investment underway by the Agency for Healthcare Research and Quality (AHRQ) and other public policy organizations to identify further evidence-based medicine practices that could be used for measurement. And the National Quality Forum (NQF) is leading focused efforts to collect and normalize data, and endorse additional performance measures.

Article By Susanne Madden of physicians Practice http://www.physicianspractice.com/physician-compensation/new-measures-pay-performance-programs?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=31102013

READ MORE - New Measures in Pay-for-Performance Programs

Screening Services Approved Billing Medicare Patients (Noridian)

Noridian Healthcare Solutions (Noridian) has had increased call volume regarding claim denial for approved screening services.

If a service is truly a CMS approved screening service, providers should bill the appropriate screening ICD-9 "V code" diagnosis and procedure code. (Most routine/screening ICD-9 "V codes" are not payable.) If the service is diagnostic, providers must bill the appropriate diagnosis code supporting the medical condition for the billed procedure code. For view billable screening diagnosis codes, go to the CMS Internet Only Manual (IOM) Medicare Claims Processing Manual, Publication 100-04, Chapter 18 at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf.

See additional CMS preventive and screening service resources at:

https://med.noridianmedicare.com/web/jeb/topics/preventive-services.
Monitored Anesthesia Care (MAC) (00100-01999) used for screening services should only be done when the patient has one or more co-existing medical conditions. Anesthesia providers should use the QS modifier for MAC when one or more of the co-existing medical conditions are present. Providers must bill the diagnosis code for the co-existing condition along with the screening diagnosis code on the claim. The co-existing medical condition diagnosis code must be linked the service billed on detail line of the claim. If the patient does not have any co-existing medical conditions provider can bill for conscious sedation (99144-99150).

If there are questions in regards to payment, call the Provider Call Center or use the Interactive Voice Response (IVR) system to check a claim status.

Last Updated Oct 25, 2013

 

From Noridian

READ MORE - Screening Services Approved Billing Medicare Patients (Noridian)

2013-2014 Influenza (Flu) Resources for Health Care Professionals

MLN Matters® Number: SE1336
Provider Types Affected

This MLN Matters® Special Edition article is intended for all health care professionals who order, refer, or provide flu vaccines and vaccine administration to Medicare beneficiaries.
What You Need to Know

Keep this Special Edition MLN Matters® article and refer to it throughout the 2013 - 2014 flu season.

Take advantage of each office visit as an opportunity to encourage your patients to protect themselves from the flu and serious complications by getting a flu shot.
Continue to provide the flu shot as long as you have vaccine available, even after the new year.
Don't forget to immunize yourself and your staff.

Introduction

The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare Part B reimburses health care providers for flu vaccines and their administration. (Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.)

You can help your Medicare patients reduce their risk for contracting seasonal flu and serious complications by using every office visit as an opportunity to recommend they take advantage of
Medicare's coverage of the annual flu shot.

As a reminder, please help prevent the spread of flu by immunizing yourself and your staff!

Know What to Do About the Flu!

Educational Products for Health Care Professionals
The Medicare Learning Network® (MLN) has developed a variety of educational resources to help you understand Medicare guidelines for seasonal flu vaccines and their administration.

1. MLN Influenza Related Products for Health Care Professionals

• MLN Matters® Article MM8433: Influenza Vaccine Payment Allowances – Annual Update for 2013-2014 Season – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf
• Quick Reference Information: Medicare Part B Immunization Billing chart - http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf
• Quick Reference Information: Preventive Services chart - http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf
• Preventive Immunizations booklet – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Preventive-Immunizations-ICN907787.pdf
• MLN Preventive Services Educational Products Web Page  - http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html
• Preventive Services Educational Products PDF – http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/education_products_prevserv.pdf

2. Other CMS Resources

• Seasonal Influenza Vaccines 2013 Pricing - http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2013ASPFiles.html
• Immunizations web page is located at http://www.cms.gov/Medicare/Prevention/Immunizations/index.html
• Prevention General Information is located at http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html
• CMS Frequently Asked Questions - http://questions.cms.gov/faq.php  
• Medicare Benefit Policy Manual - Chapter 15, Section 50.4.4.2 – Immunizations - http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf   
• Medicare Claims Processing Manual – Chapter 18, Preventive and Screening Services http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf

3. Other Resources

The following non-CMS resources are just a few of the many available where you may find useful information and tools for the 2013 – 2014 flu season:

• Advisory Committee on Immunization Practices -  http://www.cdc.gov/vaccines/acip/index.html  
• Flu Clinic Locator - http://www.flucliniclocator.org
• Other sites with helpful information include:
  • Centers for Disease Control and Prevention - http://www.cdc.gov/flu;
  • Flu.gov - http://www.flu.gov; 
  • Food and Drug Administration - http://www.fda.gov;
  • Immunization Action Coalition - http://www.immunize.org;  
  • Indian Health Services -  http://www.ihs.gov/;  
  • National Alliance for Hispanic Health - http://www.hispanichealth.org;  
  • National Foundation For Infectious Diseases - http://www.nfid.org/influenza;
  • National Library of Medicine and NIH Medline Plus - http://www.nlm.nih.gov/medlineplus/immunization.html;
  • National Network for Immunization Information - http:/www.immunizationinfo.org;
  • National Vaccine Program - http://www.hhs.gov/nvpo;
  • Office of Disease Prevention and Health Promotion - http://odphp.osophs.dhhs.gov;   
  • Partnership for Prevention - http://www.prevent.org; and
  • World Health Organization - http://www.who.int/en

Beneficiary Information
For information to share with your Medicare patients, please visit http://www.medicare.gov on the Internet.

READ MORE - 2013-2014 Influenza (Flu) Resources for Health Care Professionals

Update to the Provider Remittance Advice Impacts as a Result of the Jurisdiction E Part B MAC Transition

Noridian has identified an impact to the content of the provider remittance advices as a result of the transition of pending workload from Palmetto Government Benefit Authorizers (PGBA) to Noridian.

Providers may notice the Glossary, Group, Reason, MOA, Remark and Adjustment Codes section of their remittance may contain verbiage that does not match the services provided.  The group codes and liability assigned to payments and denials may also be incorrect.

One example providers may notice is for claims that previously displayed CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee Arrangement) for payment.  These paid claims may incorrectly display on the remittance as a PR-150 (Payer deems the information submitted does not support this level of service).  As of 9/20/2013, this has been updated in Noridian's system. Please be aware that remittances generated on or after 09/20/13 may still show the incorrect verbiage depending on the status of the claim when the system was updated.

Noridian is currently working to correct history and provide corrected remittance advices to impacted providers.  Additional updates will be provided when they are available.

10/22/13 Update: Noridian has completed updating a large part of claims history that contained incorrect provider remittance advice messages.  We continue to work to update any remaining claims with incorrect messages.

Corrected provider remittance advices for all claims that were part of the history correction are expected to be generated in the next few weeks.  Further information regarding the dates and generation of the remittances will be provided when they are available.

Last Updated Oct 24, 2013

READ MORE - Update to the Provider Remittance Advice Impacts as a Result of the Jurisdiction E Part B MAC Transition

“Expanded Coverage Under the Affordable Care Act: Information for Health Care Professionals” Fact Sheet — Released

The “Expanded Coverage Under the Affordable Care Act: Information for Health Care Professionals” Fact Sheet (ICN 908826) was released and is now available in downloadable format. This fact sheet is designed to provide education on the Health Insurance Marketplace under the Affordable Care Act. It includes information health care professionals need to know about the Marketplace, an explanation of how the Affordable Care Act expands access to health coverage, and an explanation of the Marketplace, how it affects health care professionals and their patients, and resources.
From Medicare Learning Network eNews update.

READ MORE - “Expanded Coverage Under the Affordable Care Act: Information for Health Care Professionals” Fact Sheet — Released

Health Professional Shortage Area (HPSA) Bonus Payments - 2014 Update

MLN Matters®Number: MM8463
Related Change Request (CR) #: CR 8463
Related CR Release Date: September 27, 2013
Effective Date: January 1, 2014
Related CR Transmittal #: R2794CP
Implementation Date: January 6, 2014
Provider Types Affected

 This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare contractors (Fiscal Intermediaries (FIs), carriers and A/B Medicare Administrative Contractors (A/B MACs)) for services to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 8463, from which this article is taken, alerts you that the annual HPSA bonus payment file for 2014 will be made available by the Centers for Medicare & Medicaid Services (CMS) to your Medicare contractor and will be used for HPSA bonus payments on applicable claims with dates of service on or after January 1, 2014, through December 31, 2014. These files will be posted to the internet on or about December 1, 2013. You should review http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html   on the CMS website each year to determine whether you need to add the AQ modifier to your claim in order to receive the bonus payment, or to see if the ZIP code area in which you rendered services will automatically receive the HPSA bonus payment. Note that Medicare contractors will continue to accept the AQ modifier for partially designated HPSA claims. Please be sure that your staffs are aware of this update.

Background
Section 413(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 mandated an annual update to the automated HPSA bonus payment file. CMS automated HPSA ZIP code file is populated using the latest designations as close as possible to November 1 of each year. The HPSA ZIP code file will be made available to CMS contractors in early December of each year. CMS contractors shall implement the HPSA ZIP code file and for claims with dates of service January 1 to December 31 of the following year, shall make automatic HPSA bonus payments to physicians providing eligible services in a ZIP code contained on the file.

Additional Information
The official instruction, CR8463, issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2794CP.pdf  on the CMS website.

Last Updated Oct 21, 2013

READ MORE - Health Professional Shortage Area (HPSA) Bonus Payments - 2014 Update

What is PQRS?

What is PQRS?

Created in March 2007, the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. In 2011, CMS changed the program name to the Physician Quality Reporting System (PQRS).

Outcome is qualified to report all Individual Measures and Measures Groups, which can be reported to CMS by physicians and other caregivers in hospitals or physician practices. The PQRS offers the opportunity to earn a 0.5% incentive payment.

Learn more at www.outcome.com/pqrs.htm.

READ MORE - What is PQRS?

Outcome PQRS Registry: a simpler approach to getting your reimbursement

The PQRS registry by Outcome, A Quintiles company, is a CMS qualified, web-based registry that provides practices with a simpler approach to receiving their reimbursement.

The registry approach significantly simplifies the reporting process by using clinical data that clinicians are accustomed to and separating the process from the claims submission process. Data can be entered in the registry at any time throughout the year and then is reported as a single transmission to CMS by Outcome at the end of the reporting period (e.g. annually).

Leverage Existing Data
Our unique registry allows practices to leverage data that you have already collected and reduces data entry with an upload tool and integration capabilities, allowing data exchange to and from other practice systems, including practice management systems and electronic health record (EHR) systems.
Configurable by Provider
Whether you are a one-physician or a multi-specialty medical group, each practice enrolled receives an account tailored to their requirements and has the ability to select their measures, choose the reporting time period, view the data that has already been collected, and add additional data if needed. Physicians who also participate in other Outcome programs, such as our hospital-based programs and programs with physician and surgical specialty societies, may also be able to see data from those programs in their account.

Advice on Best Implementation
Our PQRS team has analyzed PQRS specialty by specialty to find the most efficient measure selections (least work effort required approach for each specialty). Our knowledgeable physician-led team is available to provide practices with guidance on the most efficient and effective methods to report their PQRS measures based on physician specialty requirements.
Electronic Prescribing (eRx) Incentive Payment
The Outcome registry offers practices the opportunity to participate in the CMS eRx Incentive Program and qualify for the 0.5% eRx incentive payment through the same program—at no additional cost. The Outcome registry includes the option to collect the appropriate eRx measure and Outcome transmits the data to CMS.

 Benefits of the PQRS Registry by Outcome, a Quintiles company
• Eligible professionals who successfully report a designated set of quality measures on claims may earn a bonus payment
• Reduces data entry with an upload tool and allowing for data exchange to and from other programs and practice systems, including practice management and electronic health record systems
• Support from our highly-trained Help Desk team, dedicated to providing training and real-time technical support and available by phone and email
• Provides support to help physicians choose which quality measures are most suitable to their area of practice
• Creates a registry view of data for quality improvement
• Registry method allows clinicians to focus on patient care and no need for changing coding practices with CPTII and G codes
• Provides flexibility in participation by separating PQRS reporting from claims submissions so that data can be entered retrospectively or concurrently
• Allows physicians to see their results before they transmit to CMS

View a Webinar Register today at www.outcome.com/pqrs.htm.
Learn More For more information, please contact us:
(617) 715–6898 pqrs@quintiles.com

What is PQRS?
Created in March 2007, the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. In 2011, CMS changed the program name to the Physician Quality Reporting System (PQRS).
Outcome is qualified to report all Individual Measures and Measures Groups, which can be reported to CMS by physicians and other caregivers in hospitals or physician practices. The PQRS offers the opportunity to earn a 0.5% incentive payment.
Learn more at www.outcome.com/pqrs.htm.

READ MORE - Outcome PQRS Registry: a simpler approach to getting your reimbursement