Of almost 20 docs in my group I am the only one that was able to navigate the horribly complicated rules to get my 1.5% bonus. It worked out to about $1,300 dollars. Many doctors around the country have been frustrated by the lack of success in their reporting and the lack of guidance by CMS for why they failed.I learned at a meeting today about a possible reason why. It's the fault of the clowns at Medicare.
When my billing company submits my CPT® code to Medicare for me to get paid, they must attach up to four ICD codes describing the disease states. For PQRI reporting, there are over 100 quality indicators a doc can submit for tracking. Only certain ICD codes work with certain CPT® codes which only work with certain PQRI indicators. It gets very complicated.I have previously discussed the specifics for PQRI reporting.
I found out today many docs may not have qualified because of the way the government PQRI computers crunched the data (imagine that). You see, if my quality indicator was for antiplatelet use in stroke, and I submitted to CMS stroke as the 4th ICD code, along with three comorbid conditions ( like DM, COPD, CAD), unless I submitted stroke as diagnosis #1, PQRI would reject my submission. So CMS accepts your E&M code with stroke listed as the 4th diagnosis to get paid, but when that claim makes it to the PQRI folks, because stroke was diagnosis #4 and not diagnosis#1, PQRI would reject the submission and doctors all over this country were dinged for not reporting on 80% of qualified patients.
I heard that CMS was going to go back to all of 2007 claims to fix this problem. I have also been told the problem has been fixed for 2009.
LINK TO E/M POCKET REFERENCE CARD POST
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This does not surprise me. That the likely cause of failure of a program they set up is failure to make their systems talk to each other. This is what government take over will look like. It's a week from 2009, and CMS is just now figuring out how stupid they are and why no docs have any faith in their ability to make PQRI reporting fair.
I also found out that PQRI indicator #36 calls for rehab ordered for all "intracranial" hemorrhage. During my meeting today I found out that the only ICD codes linked to this quality indicator are "intracerebral" hemorrhage. Sub dural bleeds, which are intracranial, are excluded. So are subarachnoids. They have problems even defining what they are trying to measure. Again, that doesn't surprise me.
You can see much more in my free lectures on medical billing and coding.
You can see much more in my free lectures on medical billing and coding.
Why not add this to those "Fail" pictures you include on your blog all the time.
ReplyDeleteSeems justified.
But at least you can call yourself an "EP!" (CMS's term for "Eligible Professional")
Hmmm. Whatever happened to "doctor?"
Anyway, if I do some back-of-the envelope calculations, if $1300 represents 1.5% of Medicare fees withheld, then you saw $86,666 worth of Medicare patient visits. If we assume you earn, say, $80 per Medicare visit, you saw at least 1083 patients and documented their meaningless code algorithms 1083 times. This, of course, meant 1083 times you saw patients a shorter period of time as documentation requirements superseded care delivery because you wanted to be SURE to earn your income, right?
Are your patients any better off for it?
I doubt it. But you made your measly 1.5%.
And now we learn they can’t even get the algorithm right.
Whoopty doo.
This is so disturbing... and so typical of bureaucracy. Ack!
ReplyDeleteThis business sounds like something Kurt Vonnegut would have written in a science fiction novel about the future of medical care.
ReplyDelete