News from the AOA's Blog

Medicare Physician Quality Reporting Initiative (PQRI) bonus payments and “feedback reports” are scheduled to be issued during the second half of this month, according to the U.S. Centers for Medicare & Medicaid Services (CMS). The payments and feedback will reflect performance in PQRI in 2008.

Doctors who earned a bonus payment should receive the payment in the same manner they receive reimbursement from their Medicare contractor for physician services.

This fall some doctors might also receive a long overdue payment for participating in PQRI in 2007.

The CMS identified a technical error that prevented some physicians from properly receiving a bonus payment last year, and decided to “re-run” the 2007 analysis and to make payments to doctors who had not received the bonus they deserved.

The AOA does not know whether any optometrists will benefit from this “re-run.”

Instituted by the CMS in 2007 under a congressional mandate, the PQRI is voluntary through 2010.

Doctors can earn a lump sum bonus payment based on their total Medicare allowed charges by reporting specified “quality measures” which signal that the physician is following certain accepted protocols that are supposed to contribute to high quality care.

The CMS provides some additional information in the feedback reports.

Doctors who participated but did not qualify for a bonus often want to check the data CMS recorded on their performance.

Last year, many physicians struggled to access the feedback reports and found the information lacking enough detail to be truly informative. The CMS promises better reports and better access. Unfortunately, this feedback will be too late for most doctors to have time to make any modifications, if necessary, to their 2009 reporting to make sure they get a bonus for their work this year.

“With quality measurement expected to become an increasingly important factor in payment and access, practitioners may want to obtain the feedback reports to see how their performance was rated,” said Rebecca Wartman, O.D., from the AOA’s Third Party Center. “Eventually payers and patients will havc access to physician quality measurement results.”

A sole proprietor physician who participated in PQRI using only a National Provider Identifier (NPI) should be able to obtain a feedback report directly from the Medicare contractor.

Look for more information about this process in upcoming AOA publications as well as on the AOA Web site.

Other physicians will need to register for access through Medicare’s Individuals Authorized Access to CMS Computer Services – Provider Community (IACS-PC), and then access their provider reports through QualityNet. Doctors who have not enrolled or re-enrolled in Medicare since 2003 might have to go through that cumbersome process before gaining access to IACS.

In fact, the AOA Washington office strongly urges members to undertake voluntary Medicare enrollment or reenrollment very carefully to avoid mistakes that can keep a practice from being paid for many months.

IACS registration may take several weeks alone.

Practitioners who have not used their IACS accounts for 60 days are advised to call the IACS-PC External User Services Help Desk to reinstate their passwords.

See http://www.cms.hhs.gov/PQRI and http://www.aoa.org/PQRI.xml for more information, as well as articles in AOA publications.

For IACS, the AOA strongly recommends working with the External Users Services (EUS) Help Desk at 1-866-484-8049, TTY/TDD at 1-866-523-4759 (Monday through Friday 7 a.m.-7 p.m. EST) or via e-mail at EUSSupport@cgi.com.

For PQRI assistance, including accessing the PQRI Portal, contact the PQRI Help Desk at 866-288-8912 (Monday through Friday 7 a.m.-7 p.m. CST) or via e-mail at qnetsupport@sdps.org.