tci Medicare Compliance & Reimbursement - 2007 Issue 14
PHYSICIANS: PQRI 'Cap' May Force You To Report More Services
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Article Overview
This article discusses a CMS explanation of how the Medicare quality reporting incentive cap works for physicians participating in PQRI. It is relevant to clinicians, practice managers, and coding/billing staff who track quality reporting performance and Medicare incentive payments. The article covers the general structure of the cap, why CMS says it exists, and why reporting more applicable services may affect the incentive outcome.
Why This Topic Matters
Understanding the cap is important for practices that participate in Medicare quality reporting because it can influence whether reported services translate into the full available incentive payment.
What You Will Learn
- How the Medicare quality reporting bonus cap is described by CMS
- Why reporting volume can affect eligibility for the full incentive
- The general reasons CMS gave for applying a cap to quality reporting payments
- Why practices may need to review reporting patterns across applicable services
Who Should Read This
- Physicians
- Medical practice managers
- Medical coders
- Medical billers
- Quality reporting staff
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