Forum - Questions & Answers

Jun 4th, 2013 - Jponchel

PQRS reporting

I curently charge anesthesia services for an Anesthesiaologist at a critical access hospital and recently went through and audit, one of their findings is that there is a inititve through CMS where the physician can receive a 1.5% increased payment if certain quality measures are documented. These measures are reported by using category II codes from the CPT® book. From what I have researched I have found that these are coded, a $0.00 charge will appear on the patients CMS billing form and then the reporting electronically is done via the physicians NPI number. My question is this I have found several articles that indicate "critical access hospitals" are eligible for this but not eligible to participate so I was wondering if anyone was familiar with this incentive that could offer some input on it.
see below:

"Eligible But Not Able to Participate
Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate:
• Professionals who provide Part B services, but bill Medicare at a facility or institutional (Part A) level.
• Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider’s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services.
• Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing, cannot participate, since the CAH does not include the individual provider NPI on their Institutional (FI) claims.

Services payable under fee schedules or methodologies other than the PFS are not included in PQRS (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals [including method I critical access hospitals], rural health clinics, ambulance providers, and ambulatory surgery center facilities).
Eligible professionals participating in PQRS should familiarize themselves and their office staff with the PQRS measures that appear to apply to their patients for the relevant program year. To access the measures list and related materials, click on the "Measures Codes" page in the left-hand column of the CMS PQRS website at http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS",



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