The Patient Protection and Affordable Care Act of 2010 — usually referred to as “health care reform” in polite dinner conversation — has spawned a number of changes in the administration of Medicare at the Centers for Medicare & Medicaid Services (CMS).
The latest is a facelift for the Physician Quality Reporting Initiative (PQRI), which CMS has renamed the Physician Quality Reporting System (PQRS) and whose workings have been changed as per the new law. CMS detailed the 2011 changes to the incentive program in an update to the PQRI section of its site (not yet renamed PQRS).
Changes include a new appeals process for physicians dissatisfied with CMS decisions regarding their program participation, as well as updated code and terminology sets. Participating radiologists could see the most change: A new system — co-developed with the American Medical Association and American College of Radiology — will remind women older than 40 about scheduling their next mammogram; and the CMIO website reports that recent changes in terminology could affect diagnostic radiologists, interventional radiologists and radiation oncologists.
The bottom line? In 2011, group practices could qualify for a 1% incentive, and individual physicians could earn an additional incentive of 0.5% by meeting a number of criteria for maintaining their certification. To assist providers in figuring out where they fit into the PQRS picture, CMS has updated several of its answers to frequently asked questions over the last few months.