This New Year of 2015 once again holds changes in PQRS code submission to Medicare. Medicare has expired Measure #30, Antibiotic Administration and changed a couple of the codes for Measure #193 Perioperative Temperature Management. These changes are address below and you can find the complete Measure descriptions from the PQRS Manual attached.
As in the past, there are multiple ways PQRS coding can be reported. There are several registry options (however, not all are currently available to anesthesia) or ABI can submit these codes via claims based reporting. If you would like us to send your PQRS coding via claims based reporting, it is important you submit the coding information to us. This information needs to be clearly noted on the charge information you send for billing.
General information – In 2015, the 12-month reporting period for the 2017 PQRS payment adjustment, you must report on 9 measures across 3 National Quality Strategy (NQS) domains for at least 50 percent of your Medicare patients seen. If fewer than 9 measures apply, as is the case for anesthesia services, the Measure Applicability Validation (MAV) will be applied by Medicare. This process evaluates all Medicare claims submitted and determines whether any additional measures should have been reported. If there are more than 15 patients in the denominator of those additional measures, the provider should have reported PQRS and will be subject to the 2 percent payment adjustment in 2017. If modifier 8P (measure not followed, reason not specified) is submitted for any PQRS, the reporting for this patient will not count.
Non-Anesthesia Providers – So if you bill pain injections associated with chronic pain along with E&M services (office visits), you are subject to many more Measures you could/should be reporting (approximately 100 Measures). Others of you have other specialties. If this applies to you and you have questions about PQRS, please contact Stephanie or Phil to obtain a copy of the entire PQRS Manual in order to better understand these Measures and what is required by you as a billing professional.
Example of a format that can be sent to ABI for claims reporting (Anesthesia Services):
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Editor: Philip Blann (pblann@anesthesiabilling.com).
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