Second PQRS reporting period begins July 1

June 30, 2011

It is not too late to participate in Medicare’s 2011 Physician Quality Reporting System (PQRS) program and qualify to receive incentive payments, according to the U.S. Centers for Medicare & Medicaid Services (CMS). A new six-month reporting period begins July 1.   

Again this year, Medicare’s PQRS [formerly known as the Physician Quality Reporting Initiative (PQRI)] program has two reporting periods: a 12-month reporting period that extends from Jan. 1 to Dec. 31 and a six-month reporting period that extends from July 1 to Dec. 31.

Eligible health care professionals (EPs) who satisfactorily report PQRS measures during the six-month reporting period will be eligible to receive a PQRS incentive payment equal to 1 percent of their total Medicare Part B allowed charges for services performed during the reporting period.

Most optometrists participate in the PQRS program through claims-based reporting of individual measures. PQRS claims-based reporting involves the addition of CPT Level II quality-data codes (QDCs) to claims submitted for services when billing Medicare Part B. 

To qualify for incentives, practitioners must report on at least three individual measures for at least 50 percent of applicable patients.  

PQRS measures can be reported for patients with:

  • Age-related macular degeneration (AMD), wet or dry
  • Glaucoma, primary open-angle only, or
  • Diabetes, insulin- or non-insulin-dependent.

Eligible health care professionals do not need to sign up or pre-register to participate in the PQRS. 

Submission of QDCs for individual PQRS measures to the CMS on Medicare claims will automatically initiate the doctor’s participation in PQRS.

As reported last month in AOA News, optometrists across America earned a total of $2,172,814 in PQRS incentives for 2009. 

Optometrists participating in the PQRS program during 2009 received an average (mean) payment of $1,168 – with some receiving bonuses of as much as $21,276. The median payment to an optometrist was $653.

Because Medicare has  reduced the percentage of total allowable charges that practitioners receive as PQRS bonuses from 2 percent in 2010 to 1 percent in 2011, payments for 2011 could be somewhat smaller than those for 2010, according to AOA Practice Advancement Committee member Rebecca H. Wartman, O.D. 

“However, they will certainly be large enough to make participation in the PQRS worthwhile for most optometrists,” Dr. Wartman said.

Practitioners can earn an additional 1 percent bonus through the Medicare e-Prescribing Incentive Program, by prescribing pharmaceuticals electronically 25 times over the course of 2011 (provided they are not participating in the Medicare Electronic Health Records Incentive Program this year). 

“Optometrists have plenty of time between now and the end of the year to e-prescribe 25 times and earn that bonus,” Dr. Wartman noted.

Overall, optometrists have embraced the PQRS program, ranking ninth among all physician specialties in participation, Dr. Wartman noted. 

Nearly one in every five optometrists who see Medicare patients (19.78 percent) participated in the PQRS program during 2009, according to a recent CMS report.

However, that was slightly below the participation rate (20.91 percent) for all eligible professionals and less than half the participation rate for ophthalmology (38.8 percent).

For detailed instructions on quality measure reporting, see “Physician Quality Reporting System: PQRS 2011 made easy” in the March edition of AOA News.

“PQRS Made Easy,” a continuing education lecture by Dr. Wartman and Harvey Richman, O.D., will be offered Saturday, June 18 at 3 p.m., during Optometry’s Meeting® in Salt Lake City, Utah.

“This course covers all the PQRI measures for optometry and how to file them successfully,” Dr. Wartman said. 

COPE approval for the course is pending. The course will be offered as part of the Optometry’s Meeting® program for just $20.

AOA members can find additional information on the PQRS program and links to CMS PQRS resources on the AOA Web site PQRS page (www.aoa.org/PQRS).

They can also access extensive PQRS information through AOA’s free member coding and billing resource AOA Coding Today (http://aoa.codingtoday.com).

2011 Physician Quality Reporting System measures

  • Measure 12 – Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
  • Measure 14 – Age-Related Macular Degeneration (AMD): Dilated Macular Examination
  • Measure 18 – Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
  • Measure 19 – Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
  • Measure 117 – Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient
  • Measure 140 – Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
  • Measure 141 – Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15 percent OR Documentation of a Plan of Care

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