Physician Quality Reporting System (PQRS)

Posted by mgsionline on August 1st, 2013

In the history of the US Healthcare domain, several physician payment models, including fee-for-service, episode-based payment, and patient-centered medical home were introduced. However, most of these models failed to address the efficiency or measure of the outcomes. It is to improve the quality of patient care that provider billing payment models like Physician Quality Reporting System (PQRS) came into effect. This Pay-for-Reporting model offers eligible physicians great incentives and payment adjustments if they prudently report quality measures for the patient care services provided. Here is an overview of this payment model:

Objective: According to PQRS provider billing payment model, Healthcare Providers will earn a bonus payment of 0.5% on reporting a minimum of 3 individual, quality measures for the patient care services rendered by them.

Challenges:

• Centers for Medicare and Medicaid Services (CMS) proposed for this year that this reporting must happen between the time period of January 1, 2013 and December 31, 2013.
• In case the eligible Healthcare Providers fail to submit satisfactory medical billing reports on the specified time period, then they will suffer a 1.5% payment penalty cut in 2015. It is also believed that this penalty might rise to 2% in 2016.
• The less financial incentive and the fear of rising penalty cuts made many managed care professionals feel hesitant to participate in this program.
• As the Affordable Care Act introduces several reforms to provider billing payment models every now and then, the aforementioned aspects might take different shapes in the upcoming years.

Pay-for-Performance System: This system overcomes the challenges of the PQRS model. It offers financial incentives to Healthcare Providers and Groups if they meet a defined target of quality measures. It not only rewards the exceptionally-performing physicians, but also the ones who show improvement. Implementing such a quality system in one’s practice is quite challenging. Therefore, Healthcare Providers are advised to take a medical billing company’s help to implement the best provider billing payment model in which includes help in tracking and building the reports required apart from plain vanilla medical billing and collection services.

About MGSI:

Based in Florida, MGSI is a reputed medical billing company, which offers exceptional medical billing and collection services to its clients across the US. In addition, this 20-year old medical billing company also helps Providers to implement the best payment model in their practice to earn good incentives while improving patient care. To know more details, log on to www.mgsionline.com