CMS released the Final Rule on the Physician Fee Schedule containing next year’s Physician Quality Reporting System (PQRS) requirements on October 31, 2014. As expected, Measure #30, Timing of Antibiotic Prophylaxis-Administering Physician, has been deleted from the list of measures available for either claims-based or registry reporting. So has the Back Pain Measures Group (Measures ##148-151) and Measure #142, Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications, but CMS did not ultimately remove Measure #109, Osteoarthritis: Function and Pain Assessment, from the list.
For 2015, the following are the basic PQRS measures applicable to anesthesiology:
And the following is a sample of PQRS measures that may be applicable to your pain medicine practice:
Please note that neither of these lists necessarily represents the complete universe of measures that you may be able to report. There may be others that also apply to your practice, and there may be measures groups that you would choose... 
The Centers for Medicare & Medicaid Services (CMS) began the National Correct Coding Initiative (CCI) edits as an initiative to promote correct coding by providers and to prevent Medicare payment for improperly reported services. The CCI program consists of automated edits that are part of the claims processing systems deployed by the Medicare Administrative Contractors (MACs). Specifically, the CCI edits contain pairs of Healthcare Common Procedure Coding System (HCPCS) codes (i.e., code pairs) that generally should not be billed together by a provider for a patient on the same date of service. All code pairs are arranged in two columns. Column 1 contains the primary code and column 2 the secondary code or service format. The column 2 code is generally not payable with the column 1 code.
Under certain circumstances, a provider may bill the column 2 service in a CCI code pair by including a modifier on the...
Numerous anesthesiologists have expressed confusion about the requirements for reporting Physician Quality Reporting System (PQRS) measures next year. It is very important that every eligible professional (EP) successfully participate in the PQRS program in 2015; failure to do so will mean a two-percent reduction in their Medicare payments in 2017.
There are five methods for submitting PQRS data to CMS:
Claims-based reporting (on Medicare Part B claims)
Registry-based reporting
Electronic health record (EHR) reporting using certified EHR technology (CEHRT) or a data submission vendor
Qualified clinical data registry (QCDR) reporting
Group practice reporting
While these methods have all been established previously, and none of them are new for 2015, CMS has proposed significant changes to the numbers and types of measures that must be reported to avoid the penalties. We will not know for certain whether it will suffice to report one measure, three measures or nine measures as proposed until...
The Affordable Care Act (ACA) was passed four years ago and there have been plenty of ups and downs regarding its rollout. Now that it appears to be here to stay, healthcare providers need to change their focus on the impact the new health insurance exchanges may have on their financial bottom line.
Individuals who buy coverage on the Marketplace and fall below certain income levels can qualify for advance payments of a premium tax credit (APTC) to help pay their premiums. As long as these individuals pay their share of the first month of premium, insurers cannot later terminate their coverage without first giving a three-month (90-day) grace period to pay. The Obama Administration saw this rule as a means to further the continuity of care for those who cannot afford premiums for certain months due to job loss or other financial constraints. Many healthcare experts see the grace... 
Analogies make us stop and think. Sonya Pease, MD, chief medical officer of TeamHealth, invites us to consider that customers of service industries such as restaurants reward outcomes rather than work processes in this Communiqué’s lead article, Working for Tips…. Much as patron satisfaction is key to success in the restaurant business, patient satisfaction is an outcome that physician compensation is going to reflect, whether we believe that patients are appropriate judges of quality medical care or not.
Patients’ perception of the caliber of the care they receive is determined in part by their doctors’ communication skills. Implementing multimodal pain and post-operative nausea and vomiting programs are very important, and so are the clinician’s self-introduction and expressed concern for the patient’s comfort. Think about the waiter’s keeping customers informed about delays and asking whether they need anything. These are skill sets most physicians “didn’t learn in residency but it is imperative we...