Purchasers of healthcare are beginning to take a more active role in ensuring they receive value for their health care dollars, and these savvy shoppers want to develop programs to increase the quality and efficiency of the care they purchase. This movement has given rise to the concept of value-driven healthcare, commonly called value-based purchasing. Over the next three months, “From the College” will take a look at this type of purchasing and provide rheumatologists and rheumatology health professionals with practical advice on how to stand out to these value-based purchasers.
Practical Advice for the Rheumatologist on Medicare PQRI
It is not too late to participate in the Centers for Medicare & Medicaid Services’ (CMS) 2009 Physician Quality Reporting Initiative (PRQI). Participation is voluntary, but providers who participate now will better prepare themselves for probable future reporting requirements while qualifying for an incentive payment from CMS.
Round One for PQRI
Complex requirements and confusion typify start of Medicare quality initiative
Recovery Audit Contractors: What Are the Facts?
In March of 2008, by Section 302 of the Tax Relief and Health Care Act of 2006, the Centers for Medicare and Medicaid Services’ (CMS) Recover Audit Contractor (RAC) program was made a permanent addition to the Centers’ goal preventing fraud, waste, and abuse in the Medicare system.
Quality Measures and Reporting
A call for professional responsibility
Physician Quality Reporting Initiative (PQRI) Changes for 2008
CMS has announced alternative reporting periods and reporting criteria for the 2008 Physician Quality Reporting Initiative (PQRI).
New Advance Beneficiary Notice
CMS has replaced the general and lab advanced beneficiary notice with the Advance Beneficiary Notice (ABN) of Non-coverage. The new titled notice requires physicians and other healthcare providers to use a new form when services are not expected to be covered by Medicare.
Boost Revenue with Denials Management, Appeals
Denials management and appeals are the two most underestimated processes in rheumatology offices. Most practices lose thousands of dollars every year because they are not following up or writing off denied claims correctly.
Working With Your National Provider Number
Beginning May 23, 2008, all practicing physicians who treat Medicare patients must start billing with a working national provider identifier (NPI). Physician and non-physician providers can make any corrections or changes pertaining to their NPIs by contacting the National Plan and Provider Enumeration System (NPPES)…
American College of Rheumatology (ACR) on Capitol Hill
“By tomorrow night, there will be so many more people on Capitol Hill who know—and are sensitive to—rheumatology and the issues that impact you and your patients. There is no substitute for what you are doing,” says Martha M. Kendrick, a partner at Patton Boggs, LLP, the ACR’s lobbying firm. This is what she told the physician, health professional, and patient participants of the ACR’s 2008 “Advocates for Arthritis” advocacy event—termed a fly-in—before they took their personal stories to the lawmakers on Capitol Hill.