How Technology Streamlines PQRS Eligibility and Participation


Radiology TrendsThe American healthcare payment system often employs a “carrot and stick” approach to reimbursements. Radiologists are expressing their frustration at implementing a value-based program as dictated by the Patient Protection and Affordable Care Act. Starting in 2015, physicians will face a 1.5% reimbursement reduction penalty for not meeting requirements, which could add up to more than just frustration.

According to a study published in the Journal of the American College of Radiology, a copy of which can be requested here, there are some startling trends emerging regarding Medicare’s Physician Quality Reporting System (PQRS) program. The data shows that, depending on the radiology specialty, incentive payments varied substantially. The average diagnostic radiology incentive payment was $2,811.39, while the average for radiation oncology was $12,704.38 in 2010.

This could be explained, in part, because of the relatively small numbers of specialty radiologists registered with the Centers for Medicare & Medicaid (CMS), but, the mean bonuses given non-radiology specialties were sizeable as well, when compared to reimbursements for diagnostic radiology.

Even though the percentage of qualifying radiologists increased each year, researchers found that many radiologists experienced difficulties associated with data extraction and reporting for not taking advantage of PQRS incentives.

IT Platforms Help Streamline Process

It’s clear that we’ve entered the era of increased accountability and that payments linked to quality improvement are here to stay. Researchers found participating radiologists using a CMS-qualified registry enjoyed a 76.6% qualification rate among participants, while those using the claims-based methodology had only a 42.7% qualification rate.

However, over the three years for which both reporting options were available, a distinct minority (7.3%) took advantage of registry reporting, presumably because of radiologists’ perception that Medicare reporting was problematic.

Some solutions, including PQRS Opportunity by peerVue, could change that by simplifying registry reporting. The software identifies reimbursement opportunities, alerts appropriate staff and provides instructions for follow through in order to avoid penalties. The system also delivers the summary reporting necessary to document the event properly for CMS reimbursement.

Since PQRS will remain part of the physician reimbursement landscape for many years to come, it would be wise to invest in technology that can help you meet the demands of the marketplace and improve your overall experience with “accountable care.”

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