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Don’t Miss Out on Cash!

PQRI: Not too Late for 2009 – Start July 1st

Hurry!  July 1st is approaching rapidly!  Don’t miss out on earning a 2% incentive bonus on your total Medicare allowed charges (that’s for the entire year, not just the reporting period, and it’s for all claims, not just the ones that you report the measures on) – for an average orthopaedist, that is approximately $3,700 per MD.  If you’re in a group practice, the incentive payments will really add up. 

Check out KZA Associate Cheyenne Brinson’s article on PQRI in the May issue of The American Journal of Orthopaedics.  Click here to read the article.

Get Started Today!

As an orthopaedic practice, the Perioperative Care Measures Group is perfect for you.  Do you perform at least 30 cases per year (or 15 for July 1 – December 31) for the following CPT codes (combined, not individually)?

Hip: 27125, 27130, 27132, 27134, 27137, 27138
Fractures: 27235, 27236, 27244, 27245, 27269
Knee: 27440, 27441, 27442, 27443, 27445, 27446, 27447

Example:  A total hip arthroplasty is performed on a 66-year old female.  Standing orders indicate that cefazolin (or cefuroxime) is to be given within one hour prior to surgery and is to be discontinued within 24 hours after surgery and VTE prophylaxis is to be given within 24 hours of surgery.  All orders were followed for this patient – You have just met the requirements for the Perioperative Care Measures Group. 

You can report the measure either claims-based, G-codes and/or CPT II codes are reported with each claim, or registry-based, pay a nominal fee and upload data into a qualified registry at the end of the year.  (Click here for a list of qualified registries.)

If you start reporting now, under claims-based reporting, you report on 80% of your eligible Medicare cases (minimum 15) for the period July 1, 2009 – December 31, 2009.  Just report G8492 “I intend to report the Perioperative Care Measures Group” with your first eligible Medicare claim on or after July 1, 2009.  No sign up necessary, just report the G-code. 

There are other PQRI measures applicable to orthopaedists, likely already being captured through patient health history forms:

  • Inquiry Regarding Tobacco Use
  • Documentation and Verification of Current Medications in the Medical Record
  • Unhealthy Alcohol Use – Screening

These are considered individual measures and you must report 3 measures on 80% of your Medicare allowed charges.  At this late date in 2009, registry-based reporting is your only option.  (If you start July 1, you cannot report individual measures via claims-based reporting, only registry-based.)

We agree – at first glance PQRI seems an overwhelming, daunting program, but when you sift through and get to the meat of what applies to you, it is relatively painless for your practice to report. 

CMS released PQRI and e-prescribing guide for the office manager

CMS has posted Physician Quality Reporting Initiative (PQRI) & E-Prescribing: Implementation Advice for the Office Manager.  It contains an overview of the PQRI and advice on participating in the three 2009 PQRI options that begins in July. CMS also announced a help line and e-mail resource for PQRI participants. You can call toll-free (866) 288-8912, 8am–8pm Eastern time, or send your PQRI questions to  pqri_inquiry@cms.hhs.gov

Already participating in PQRI?

We’d love to hear from you!  Please contact Cheyenne Brinson at cbrinson@karenzupko.com or (312) 642-5616 to let us know that you are participating in PQRI.  We’d love to feature your practice in a case study about PQRI. 


Orthopaedic Course Dates at a Glance

Nashville, TN August 21–22 Gaylord Opryland Resort
Chicago, IL November 13–14 Wyndham Chicago

For more information visit www.karenzupko.com or call 312-642-5616.

KarenZupko & Associates, Inc. • 625 North Michigan Avenue, Suite 2225 • Chicago, Illinois 60611 • 312.642.5616 • FAX: 312.642.5571

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