Medicare proposal would simplify PQRI

July 30, 2009

Medicare is proposing a rule that would simplify reporting requirements for the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative and set the Medicare Physician Fee Schedule for calendar year 2010.

Medicare is proposing a rule that would simplify reporting requirements for the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative and set the Medicare Physician Fee Schedule for calendar year 2010.

The proposal would also add more measures for physicians to report under the PQRI pay-for-performance program, allow data submission from an electronic health record system and create a process to ease quality measure reporting for group practices.

The Centers for Medicare and Medicaid Services has also revised the reimbursement system for some payments. For example, it proposes to stop paying for “consultation” codes typically billed by specialists at a higher rate than equivalent “evaluation and management” services. In addition, CMS is proposing to remove physician-administered drugs from the definition of “physician services,” an action the American Medical Association has been calling for since 2002.

CMS published the rule July 13 in the Federal Register, and will accept public comment through Aug. 31. The final rule will be published Nov.1, and the revised physician payment system would be effective Jan. 1, 2010.

CMS is projecting a 21.5 percent rate reduction for physicians in 2010 based on current data, but the agency and Congress annually take measures to prevent or minimize reductions.