Medicare Compliance & Reimbursement

Your business partners could sabotage your PQRI ramp-up.

You may be all primed to go with the Physician Quality Reporting Initiative (PQRI), but you should double-check that everyone you're doing business with is equally ready. Some practices have found out the hard way that their clearinghouses and vendors aren't prepared.

One hospital-owned physician group in Lexington, NC scrambled to do an in-service on the PQRI measures once the Centers for Medicare & Medicaid Services (CMS) finalized them in June. The physician group's staff approached the challenge with a positive attitude and shared the responsibility across departments, reports Carol Penninger, senior associate with Health Management Resources in Salisbury, NC.

The only problem turned out to be in an area out of the physician group's control--its clearinghouse, Richmond, VA-based PayerPath. PayerPath has been struggling to get on board with National Provider Identifiers (NPIs) for a number of regions.

PayerPath says it'll have the NPI problem sorted out in a few weeks. (PayerPath officials didn't return phone calls seeking comment for this article.)

The PayerPath NPI problems affect physicians in 27 states, Penninger points out.

Some vendors are dragging their feet on getting the PQRI codes loaded into their electronic medical records (EMRs), complain providers.

"My vendor is not up to speed," complains Cindy O'Neill, a coder at St. Luke's Hospital in Sioux City, IA. That means the physicians are coding and documenting their visits without including PQRI information, says O'Neill. "You have to look through the records for everything."

The vendor was supposed to have added the PQRI codes to the EMR in early July but hasn't gotten to it yet. Part of the delay may come from the fact that different providers want different formats: Some want an extra sheet containing the PQRI information. But O'Neill asked for the PQRI information to go right under the physician's orders, to simplify the process.

Bottom line: You should work with your partners to make sure they're handling everything smoothly. But also treat the current six-month PQRI project as a "dress rehearsal" for future projects, when even more money may be at stake, Penninger advises.