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Optimizing Revenue By PQRS Participation

August 29, 2011

PQRS, the Medicare program paid out over 234 million US dollars in 2009 to medical professionals who subscribed to the program. However, a large segment of professionals failed to qualify, were just not aware, or lacked the inclination to take part. Out of over one million medical professionals deemed eligible to take part in the PQRS, only 210,000 subscribed in 2009. Out of the 210,000 that participated, 120,000 earned bonuses averaging 2000 US dollars each. This number could have been significantly higher had the professionals been aware of the program and its incentives.

PQRS is an initiative to make it possible for physicians to report patient records qualitatively and aims to encourage preventive care on the basis of relevant data collected from physicians’ practices. PQRS will be mandatory by 2015 and non-participating professionals will be penalized as well.

Presently, the PQRS, popularly known as the ‘pay-for-reporting system,’ is optional and attracts cash rewards, By early PQRS participation, medical professionals will get a head start by getting certification from medical authorities as well as gaining recognition and credibility in the community and medical fraternity as thorough professionals who provide conscientious and quality service to their patients leading to greater demand from patients. Also, the physicians will have set up a system that will be quite costly when participation becomes mandatory as well as avoid penalties.

The amount physicians invest in setting up the PQRS is recovered twice over in the first year alone, through the incentive program. Most physicians are considering opting in while they can earn incentives, instead of having to install the system at their own cost, without any incentive.

Once the physicians opt to go in for PQRS participation, they have to decide on the PQRS measures for patient care relevant to their practice as well as ensure that their staff too is well versed with these reporting requirements and have put procedures in place to incorporate this data on claims (50% of applicable claims are required to include PQRS data).

The healthcare providers who are not able to support these initiatives through lack of time, resources, or trained staff should think of getting expert help from outside for implementing and integrating the PQRS initiatives.

Billing and coding companies can support physicians in implementing and streamlining the PQRS processes in their facility by seamlessly incorporating these initiatives into their claims submission workflow with minimum hiccups during the transition period. They have certified and trained staff to document the relevant quality measures on the billing form.

By hiring the services of professionals from Medicalbillersandcoders.com not only will one be rid of the hassles of sourcing and training necessary staff, but also the entire process of installing and learning the PQRS system will be streamlined. Added to that, while the incentives last, the physician will not only recover the investment as well as gain increased Medicare reimbursement but will also ensure that their staff establishes procedures for identifying and integrating PQRS data as a routine part of the claims submission flow before the mandatory phase sets in.

Finally, the good standing a physician will acquire among his colleagues and community will result in optimizing revenue for the health care provider or facility since it enhances levels of a doctor’s efficiency when standard administrative responsibilities like PQRS reporting are handled by trained and expert staff.

It’s a win-win situation to get in touch with a quality service provider at the earliest.

To get more information on setting up a quality reporting system as well as other related measures through our RCM and Consultancy services, please visit www.medicalbillersandcoders.com


Category : Revenue Cycle Management