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Time is Runnning Out for Mandatory Reporting of Medicare PQRS Codes

Hopefully, by now, you have heard about reporting requirements for the Medicare PQRS.  Yes they are mandatory and yes, you need to start reporting them this year in 2013 or you will face penalties starting in 2015.

Yes, that’s two years away but the reason time is running out is this:

1) In order to “successfully” report PQRS, you must report the measures on every visit where you have billed a 98940, 98941 or 98942.  In 2013, you must satisfactorily report on both measures at least 50% of the time and perform each measure at least once to qualify for the incentive bonus.

2) The elephant in the room is this:  if your report your PQRS “incorrectly” you may be rolling out the red carpet for a Medicare audit.

If you have no clue about the whole PQRS requirements, don’t know what G-codes I am referring to and obviously haven’t started reporting, here are some quick facts:

Quick Facts About Medicare G-Codes and PQRS Reporting for Chiropractors

  • You don’t have to register or do anything special to begin reporting PQRS measures
  • All chiropractors are required to report regardless of their status (Par vs Non-Par)
  • The G-codes for the PQRS reporting are not the same as G-modifiers related to the ABN
  • DC’s who successfully report in 2013 will be eligible for a 0.5% bonus payment in 2015
  • DC’s who do not report PQRS will be penalized 1.5% starting in 2015 and their payments will continue to decrease by 2% in 2016.
  • It’s really not that hard to report!

If You Haven’t Been Reporting G-Codes Yet…

You are not alone!  It seemed to me that at the end of last year and the beginning of 2013, all I heard was articles on G codes.  Quite frankly, I assumed everyone was as sick of hearing about this as I was.  After all, it’s two codes and overall, pretty simple stuff.

Fast forward to present date (May 2013) and after having conducted 8 live seminars since the beginning of 2013 on chiropractic billing, coding and documentation, I am forced to stand corrected.

From my informal surveys of seminar attendees, apparently everyone did not get the memo.

In fact, fewer than 10% of my seminar attendees appear to be reporting G codes thus far.   And of those who are, 98% were not confident they were doing it right.

And since we are nearing the halfway point of 2013, you have precious little time to earn a bonus this year for doing so.  Perhaps more importantly, if you place this on the backburner for too long, you will risk being penalized on your future Medicare reimbursements.

Action Steps Depending on Your Self-Assessment Category

Philosophically Opposed:  I have spoken to a number of DC’s who seem to be against this reporting requirement in principle.  They simply don’t want to give “the man” any more data and don’t trust what Medicare or any other entity is going to do with it.  Naturally, they don’t want to report.  If that’s you—fine.  Don’t report and be prepared for your penalty in a couple of years.

Mathematically Challenged:  There is another category of chiropractors who are wondering if the requirements are worth their effort.  Typically these docs see very few Medicare patients and don’t really expect a bonus or penalty to impact their wallet that much.  I can appreciate this position.  If you’ve only collected $2000 from Medicare in the last year, a penalty of 1.5% ($30) doesn’t seem like much to get you motivated to report.  For that matter, the 0.5% ($10) doesn’t exactly light a fire to make you want to report either.  If you are on the fence, do the math, make your choice and move on.

Uninformed Do It Yourselfers – If you were shocked by this post, blatantly unaware of the creeping deadline and sufficiently motivated to get ‘er done, then…well…get to work!  It’s likely you have a treasure trove of articles stuffed in your inbox, amongst journals and other resources all explaining the G-codes.  You just have to read the materials, put the insight to action and do it quickly.  (BTW, if you can’t find your resources, you might want to consider spending 15 minutes and taking our fast-paced, super-simplified OnDemand webinar on How Chiropractors Can Easily Report PQRS & Medicare G Codes (click link to purchase access and watch anytime)

Almost Everyone Else:  Whether you just haven’t gotten around to reporting the G codes, are confused about the PQRS requirements for chiropractors or are just now crawling out from under your rock to suddenly hear about this “new” mandatory Medicare measure, the fact remains the same:  you need to start reporting in 2013.  Take a big breath.  It’s not that difficult.  In fact, I’ve put together an easy to understand OnDemand webinar (watch anytime) that will have you up to speed in about the time it takes the average chiropractor to see a new patient.  If you don’t dig the webinar format, I’ve also included notes so you can get going quickly.  Don’t delay – June will be here before you know it.

Those Who Are Already Reporting the Medicare G codes  —  Congratulations!  You are (definitely) ahead of the pack and are (probably) on your way to earning a bonus.  One quick test to make sure you are doing things right:  you should be receiving a N365 code on your EOB’s or your electronic claim remittals.  This N365 code indicates that Medicare has successfully received your G code measures.  Reporting but no indication you are doing it right?  Go back up one category and follow the advice there – but give yourself an extra cookie for your efforts J


PS – Blatant Commercial J —  one unique “twist” about my PQRS webinar is the “audit angle” that I discuss.  I have yet to see anyone clearly mention exactly what Medicare is going to do with the PQRS reporting and discuss potential audit triggers or traps.  So, if that’s something you wish to learn, you may also be interested in investing approx. 30 mins of your time on the How Chiropractors Can Easily Report PQRS & Medicare G Codes webinar (click link to purchase access and watch anytime)

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