ED Coding & Reimbursement Alert - 2013 Issue 10
PQRS: 4 Steps Avoid Penalty Pile Up in 2015
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Article Overview
This article explains how a general surgery practice participating in Medicare’s Physician Quality Reporting System (PQRS) can think about upcoming payment changes and reporting decisions. It focuses on the timing and organizational choices that affect incentive and adjustment pathways, including group size, reporting as an individual versus a group, and selecting a reporting mechanism. The piece is aimed at physicians, practice managers, and coding/billing professionals who need a broad understanding of PQRS-related Medicare policy changes and administrative deadlines.
Why This Topic Matters
The article helps practices understand which Medicare quality reporting decisions may influence future payment adjustments and what operational choices need attention before key deadlines.
Article Sections
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Introduction
An overview of the quality reporting topic, the practice context, and the Medicare payment changes discussed in the article.
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Step 1: Understand How ‘Bonus’ Can Turn to ‘Penalty’
Discussion of the broader shift from incentive-based quality reporting to potential future payment adjustments and the policy framework behind it.
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Step 2: Determine Your Group Size
Explanation of how group size affects reporting considerations, including CMS definitions, enrollment data sources, and timing issues.
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Step 3: Choose ‘Individual’ or ‘Group’
Overview of the choice between individual and group participation paths and the related administrative deadlines and considerations.
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Step 4: State Your Reporting Mechanism
Summary of the reporting mechanism options available within the quality reporting program and how they relate to group participation.
What You Will Learn
- How Medicare quality reporting can affect future payment adjustments
- What practice factors influence whether reporting is handled individually or as a group
- Why group size and enrollment records matter to reporting decisions
- What categories of reporting mechanisms are available under the program
- Which administrative deadlines are emphasized in the article
Who Should Read This
- Physicians
- General surgeons
- Practice managers
- Medical coders
- Billing and reimbursement staff
Codes Discussed
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