Healthcare Financial News

The Centers for Medicare and Medicaid Services (CMS) on April 17 announced steps it is taking to encourage physicians and other eligible professionals to take part in the Physician Quality Reporting Initiative (PQRI), a program designed to improve the quality of care provided to Medicare beneficiaries. These steps, including a variety of new reporting options, are intended to make it easier for eligible professionals to participate and receive feedback on their performance.

In late 2007, Congress authorized PQRI transitional bonus incentive payments in 2008. Also, in addition to submitting PQRI measure data as part of their Medicare claims submissions, eligible professionals may report data on quality measures to a medical registry, and these registries will then report that data to CMS.

Besides providing new flexibility for submitting data, registry-based reporting will provide more ways for eligible professionals to qualify for an incentive payment. Another change will be new PQRI reporting periods for eligible professionals who report using measures groups. Read the overview.

Providers that order, refer, or supply certain medical equipment and supplies, such as oxygen or power wheelchairs, need to know about a new Medicare program that may change the suppliers their patients will need to use.

The new program will begin July 1, 2008, in 10 geographic areas around the country, including Charlotte-Gastonia-Concord, N.C.-S.C.; Cincinnati-Middletown, Ohio-Ky.-Ind.; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Texas; Kansas City, Mo.-Kan.; Miami-Fort Lauderdale-Miami Beach, Fla.; Orlando-Kissimmee, Fla.; Pittsburgh; Riverside-San Bernardino-Ontario, Calif.; and San Juan-Caguas-Guaynabo, P.R. The program will expand to 70 additional areas in 2009 and to additional areas thereafter.

Patients who live in or travel to one of these 10 designated areas must now get equipment or supplies that fall within 10 product categories from a Medicare-contracted supplier. Providers are highly encouraged to provide their patients with the Medicare fact sheet entitled “What You Should Know if You Need Medicare-Covered Equipment or Supplies.”