Urology Coding Alert

• Quality: CMS unveils new quality measures in seven different categories that it wants to include in next year's Physician Quality Reporting Initiative (PQRI). The measures must win the approval of the National Quality Forum (NQF) or the AQA Alliance to make it into the PQRI.

  The proposed new measures come from the AQA Starter Set, the NQF Ambulatory measure set, and some new measures being developed with the AMA. Medicare will continue to pay 1.5-2.0 percent bonuses (or the capped amount, whichever is less) for reporting on quality indicators into 2008.

• Geographic Index: CMS also updated its geographic index of physician practice costs to reflect newer data. It remains to be seen whether this will protect Medicare from a recent lawsuit by California counties that have lost out on physician reimbursement because of inaccurate data showing them as low-cost areas.
• Imaging Reimbursement: Medicare would still cap the technical component of imaging procedures at the hospital outpatient rate.
• Compliance: CMS would close some loopholes in the physician self-referral rules that the agency says have made the program "vulnerable to abuse." In particular, you won't be able to mark up the cost of a diagnostic test that your practice purchased from another group or physician.
• E-prescribing: Computer-generated faxes would have to comply with normal standards for electronic prescriptions. Letting your computer create a fax was supposed to serve as training wheels for real electronic prescriptions, but now CMS is worried that doctors and pharmacies haven't moved beyond the fax yet.

-- For more information about CMS' proposals, go to www.cms.hhs.gov/center/physician.asp.