Pathology/Lab Coding Alert

Use alternative reporting period to prepare for 2009. If you think that pathology measures qualify for the July 1 start date of Medicare's 2008 Physician Quality Reporting Initiative (PQRI) -- think again. -I-ve heard from pathologists who-ve been led to believe that Medicare's new -alternative reporting period- rule means they could start participating in PQRI as of July 1, 2008,- says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. in Simpsonville, Ky. and publisher of the Pathology Service Coding Handbook. -That's not true. The July 1 to Dec. 31 alternative reporting period only applies to physicians who are eligible to report on at least one of four new measure groups,- Padget explains.
The measure groups pertain to diabetes, end stage renal disease, chronic kidney disease, and preventive care -- none of which impacts pathologists, according to Padget. Bottom line: -The 2008 PQRI reporting period for pathologists participating in the breast and colorectal cancer quality measures remains Jan. 1 through Dec. 31, without exception,- Padget says. Know Medicare -Alternative Reporting Period- Rules You have to read the fine print to understand Medicare's PQRI 2008 alternative July 1��"Dec. 31 reporting period. Although CMS stated in an open letter to physicians in June that -it is not too late for those who have not yet started reporting quality data to begin participation for 2008,- such general statements don't tell the whole story. Know this: CMS- Change Request 6104 states that the alternative reporting period does not apply to -individual PQRI measures using the claims-based method of reporting,- but applies only to -measures groups.- You can access CR6104 on the Internet at www.cms.hhs.gov/transmittals/downloads/R355OTN.pdf. In other words: The alternative reporting period rule doesn't apply when pathologists report individual measures based on claims reporting, according to Padget. PQRI Goal: Get Paid for Value, Not Volume PQRI is a voluntary quality reporting system that Congress initially authorized by the 2006 Tax Relief and Health Care Act, and CMS implemented in 2007. The program allows eligible professionals who satisfactorily report on the quality of services furnished to Medicare Part B Fee-for-Service beneficiaries to receive a financial incentive. CMS views PQRI as an important step toward a transformation to purchasing services based on value rather than just volume, according to Michael Rapp, MD, JD, FACEP, director of the quality measurement and health assessment group in the CMS office of clinical standards and quality in an open letter to physicians. Pathologists can now participate: Although no quality measures applied to pathology in 2007, CMS implemented two performance standards that pathologists can report in 2008. -Even if you-re sitting out the voluntary program this year, you need to get ready for a potentially expanding list of quality measures [...]