Medicare Compliance & Reimbursement

Are you trying to avoid the penalty or earn a bonus?

Get ready for two new Medicare remittance codes to indicate that your Physician Quality Reporting System (PQRS) codes are valid for 2014. The Centers for Medicare and Medicaid Services (CMS) says you can expect to receive either N620 (This procedure code is for quality reporting/informational purposes only) or CO 246 N572 (This non-payable code is for required reporting only) denial codes on your explanation of benefits (EOB) forms.

Details: Code N620 will appear for quality data control (QDC) line items entered with a $0.00 charge and is replacing the N-365 code. Code CO 246 N572 appears for QDCs billed with a $0.01 charge. Just as with other PQRS codes, CMS now encourages groups and eligible professionals to bill their 2014 QDCs with a $0.01 charge.

What to do: You should work with your billing software or electronic health record vendor to update your billing software to accept the $0.01 charge prior for implementing 2014 PQRS standards, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.

Avoid the Penalty, But Try To Get the Bonus As Well

As a reminder, for 2014 you should be reporting on nine PQRS measures across all three domains for at least fifty percent of eligible Medicare patients to receive the 0.5 percent incentive payment and avoid the two percent penalty in future years.

This can be difficult in the ED setting, so for those that satisfactorily submit fewer than nine measures across three domains, the Measure Applicability Validation (MAV) process will determine if they have met the 2014 bonus requirements.

Due to the challenges of reporting nine measures across three domains, many groups are now focusing their 2014 reporting on the measures in Emergency Care Cluster 5 to maximize their chances of earning the 0.5% PQRS bonus.

Advice: To avoid the penalty, you need to report at least three measures across one domain for at least fifty percent of applicable Medicare patients. Measures with a performance of zero percent don’t count as successfully reporting that measure, warns Granovsky.