AOA Advocacy Group Presents Webinar on 2007 Physician Quality Reporting Initiative

BACKGROUND:

The AOA Advocacy Group presented a Medicare reimbursement webinar on Thursday, May 3 to provide additional opportunity for State Executive Directors and affiliate volunteer leadership to learn more about the Centers for Medicare and Medicaid Services' (CMS) 2007 Physician Quality Reporting Initiative (PQRI). The session – which was recorded and can now be accessed online – provided important information concerning Medicare reimbursement procedures, including a 1.5% PQRI bonus payment program that will be in effect from July 1 to December 31st, 2007. In addition, the session included an update from the AOA Eye Care Benefits Center on ongoing efforts to increase plan participation for optometrists.

CMS's PQRI program establishes a financial incentive for optometrists and other health care providers to participate in a voluntary quality reporting program. Optometrists who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

At the request of AOA, Susan Nedza, MD, MBA, Chief Medical Officer for the CMS Chicago Regional Office, provided a high-level briefing on the PQRI program. Rebecca Wartman, OD, Eye Care Benefits Center Subcommittee on Coding, applied a practical application of the PQRI guidance for optometrists. An interactive Q & A session followed the CMS presentation.

PROBLEM OR ISSUE TO BE ADDRESSED:

This session can be downloaded from the AOA web site and viewed by leadership and staff of state optometric associations, as well as by AOA members. To do so, click here. After clicking on this link, you will be prompted to install the WebEx Player. Soon after that, the recording will buffer, and then play. This may take a minute or two.

AOA members are encouraged to go to the AOA Pay-for-Performance – Quality Reporting web page at http://www.aoa.org/PQRI.xml for updates and more information.

FREQUENTLY ASKED QUESTIONS:

When does the PQRI program begin?

The 2007 quality reporting period is from July 1, 2007 until December 31, 2007. The 2008 quality reporting period has not yet been determined.

Are optometrists eligible to participate in the PQRI?

Yes, optometrists are eligible professionals and are able to participate in the PQRI. There are eight eye care measures included in the PQRI quality measures. For a list of the eye care measures and the specification guidance from CMS explaining how to report these measures, see
http://www.aoa.org/documents/PQRI-Specifications-Guide.pdf.

How do I sign up to participate in the PQRI?

There is no registration or sign up process to participate in the PQRI. You simply begin to submit claims including the applicable new CPT II codes for the identified quality measures.

Do optometrists have to participate in the PQRI by reporting on measures related to eye care?

No, The PQRI is a voluntary program however the AOA encourages all optometrist to participate to be eligible for the 1.5% bonus payment and to accurately reflect the quality eye care that optometrists continue to perform.

How are quality measures reported to CMS?

Optometrists would submit claims for services as they would normally do on the claim form or via electronic claims submission process. Please be advised that some systems may not allow a “0” charge and therefore you may include a nominal fee, such as $.01. See the Eye Care Benefits Center guidance on coding and reporting of quality measures at http://www.aoa.org/x7990.xml.

Is it true that quality reporting will be mandatory in 2008? Will we be penalized for not reporting quality measures?

The 2008 PQRI program has not been determined as of yet. CMS has currently indicated that the intent is that this be continued as a voluntary reporting program. CMS will propose the guidance for the 2008 program through the regulatory process and the AOA will be reviewing this proposed rule and providing relevant comments. Congress is currently discussing payment reform proposals to replace the flawed sustainable growth rate formula. One alternative that has been discussed is a system promoting and rewarding quality and efficiency. It is unclear at the current time to know if this would become a mandatory program and whether health care professionals would be disadvantaged by lower payments for noncompliance.

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