Access the Internet for current PQRI codes, Medicare updates

For those of you who have been holding out, now is the time to buy a computer for your office, talk to your telephone company or cable provider to get on the Internet and snap yourself right into the 1990s.

Charles B. Brownlow

You have known the day was coming eventually. You have held out, believing that this would be the one time that 95% of the population would pass you by, run on ahead and finally turn around and admit you were right all along. It is not going to happen – the Internet is here to stay.

Do not worry, the fax machine you bought last year will still have its chances to ride with you as you smoothly glide into the passing lane. Your good old friends – your telephone, your fax machine, your electric pencil sharpener, your slide rule, your short wave radio, your Dick Tracy Magic Decoder Ring and even your abacus – will still have a role in “life in the fast lane.”

My introduction could launch us into a discussion of electronic health care records and computer-based practice management, but I would rather not go there just now. There will be plenty of time for that. The reason that it is critical for you to get a computer and go online immediately is that most of the good resources for life as a health care provider in 2009 are only available through the Internet.

Our pencil and paper choices are progressively more limited as we do our best to understand the world of health care insurance, vision plans, tax laws, Medicare rules and policies, basic communication with business associates and other health care providers, ordering supplies and materials, bookkeeping, investment tracking, and even corresponding with patients and other doctors.

The day has come. People prefer to “speak” with you via e-mail. No more call backs or being left sitting on hold. Send an e-mail from home at 2 a.m. if you wish, wherever and whenever the thought strikes, and read the response the next day back in your office.

Save paper

It gets better, though. Think how much paper you would have to keep on your shelves just to house all the details involved with the Medicare program alone, with its relative value units, conversion factor, fee schedule, national coverage policies, local coverage determinations, the Physician Quality Reporting Initiative or PQRI (and its potential bonus of 2% of all your Medicare allowed charges), e-prescribing (with its companion 2% bonus) and many other facets. To make matters worse, most of those documents are obsolete soon after they are printed, and a fair number of them are obsolete even before they are printed.

The Internet permits you to see documents as soon as they are created and, just as important, to not see them after they are obsolete. If you are still a little old fashioned, as I am, you will probably still print out many of the important policies that you locate, but it is pretty comforting to know that the printed page can be misplaced and still be easily replaced by retracing your steps through the Internet.

Third year of Medicare’s PQRI

This is a great time to test all this out, as Medicare’s PQRI program enters its third year. Physicians who provide services to Medicare are being encouraged to meet certain standards for providing care. The standards were chosen by physicians and other experts to highlight patient conditions that have not been fully treated in the past.

For example, it has been shown that many MDs are not insisting that their diabetic patients have their eyes examined every year. The PQRI program now permits them to earn a bonus on their Medicare payments by making those recommendations and by reporting their actions on the patients’ claim forms.

Similarly, Medicare wants to be sure that eye doctors who are providing eye exams for diabetic patients communicate back with the clinician responsible for managing the patient’s systemic health, letting them know that the eye examination was done and explaining what was found.

As you would guess, there are special numbers used to report these activities back to Medicare, called CPT II codes. Simply put, if you choose three or more PQRI-covered diagnoses that you commonly see in your office, such as systemic diabetes, age-related macular degeneration and diabetic retinopathy, you are well on your way to earning the bonus.

You can easily find on the Internet all the codes that tell you what you need for reporting what you do, along with all the rules that help you understand what has to be reported and on which lines of the CMS 1500 claim form you will place the codes.

Coding resources on the Internet

Members of the American Optometric Association can begin their search on the AOA Web site, aoa.org. That, coupled with Medicare’s Web site, cms.gov, will provide all you need – and then some.

It is good to start close to home, namely the AOA, because then you will be exposed to only the information that pertains to eye care without having to wade through information about urology, neurology and other specialties that will not interest you. The AOA Web site opens the door to as little or as much as you want to know.

First you have to decide whether you want to participate. The CMS Web site explains the advantages and the responsibilities. Once you have decided to participate, you need to consider which procedures you want to report on. That is all on aoa.org, too.

Finally, aoa.org can provide some extra instruction (an audio-supported Power Point presentation by Dr. Rebecca Wartman is available) and some examples to see how all of this fits into your real-life practice. The Web site has all that in living color, including several options to fit various situations.

For those wishing to go right to the horse’s mouth to get the original information, the AOA Web site provides direct links to key information on the CMS Web site, so you do not have to wander through the whole site to find it. In some cases, the addresses are hot links, so all you need to do is double click to fill your screen with more than you ever wanted to know about reporting your compliance with Medicare’s voluntary PQRI program.

Sure, there is a little effort and practice involved, but the rewards can be significant. The bonus can be significant, too.

Estimate your gross collections from providing care to Medicare patients during 2009. Multiply that number by 0.02 and you will have an idea what your bonus will be. It may not be enough to buy the 1965 Corvette you have had your eye on, but it may help you give key staff a raise, do a little remodeling, put a down payment on some great diagnostic equipment or take the vacation to East Overshoe, Texas, you have been dreaming about.

Just think – it all began with your decision to computerize your life.

For more information:

• Charles B. Brownlow, OD, FAAO, is a member of the Primary Care Optometry News Editorial Board and a health care consultant. He can be reached at PMI, LLC, 321 W. Fulton St., P.O. Box 608, Waupaca, WI 54981; (715) 942-0410; fax: (715) 942-0412; e-mail: Brownlowod@aol.com.