Physician Compare Website and prolonged service code updates

Are you following the rules for prolonged service codes?

The Office of Inspector General of CMS (OIG) has published a list of areas on which they will be focusing their attention this year, due to concerns that there may be fraudulent billing occurring. Of particular interest to allergists is the increased attention to the use of the prolonged evaluation and management (E/M) service codes. Specifically, the OIG announcement looked at reasonableness of services.

“We will determine whether Medicare payments to physicians for prolonged E/M services were reasonable and made in accordance with Medicare requirements,” said the announcement

If you are using prolonged service codes, especially if you have not used them in the past, you should make certain you are following the rules.

Additional PQRS data to be posted on Physician Compare Website

The Centers for Medicare and Medicaid Services (CMS) recently announced they will be expanding the quality measures included from the Physician Quality Reporting System (PQRS) on the Physician Compare website.

A total of 14 group-level PQRS measures reported by the Group Practice Reporting Option Web Interface and six individual eligible professional (EP)-level measures reported via claims are now available on Physician Compare. CMS intends to add additional measures in the future.

The 14 group-level measures include:

  • Getting a flu shot during the flu season.
  • Making sure older adults have gotten the pneumonia vaccine.
  • Screening for depression and developing a follow-up plan.
  • Screening for tobacco use and providing help quitting when needed.
  • Screening for an unhealthy body weight and developing a follow-up plan.
  • Screening for high blood pressure and developing a follow-up plan.
  • Screening for breast cancer
  • Screening for colorectal cancer
  • Comparing new and old medications.
  • Controlling blood pressure in patients with diabetes.
  • Using aspirin or prescription medicines to reduce heart attacks and strokes in patients with diabetes.
  • Monitoring patients with heart failure and a weakened pumping chamber of the heart who got a beta blocker.
  • Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions.
  • Using aspirin or prescription medications to reduce heart attacks and strokes.

The six individual EP-level measures include:

  • Screening for an unhealthy body weight and developing a follow-up plan.
  • Screening for tobacco use and providing help quitting when needed.
  • Screening for high blood pressure and developing a follow-up plan
  • Screening for depression and developing a follow-up plan.
  • Comparing new and old medications.
  • Using aspirin or prescription medicines to reduce heart attacks and strokes.