The recent collaboration between ASA, CMS and Quality Insights of Pennsylvania resulted in the addition of Physician Quality Reporting System (PQRS) Measure #44 beginning this year. abeo is encouraging anesthesia providers who perform CABG surgeries to include this measure in their PQRS reporting. Thus, anesthesiologists would report four measures: Measure #30, Measure #76, Measure #193, and the newly added Measure #44.
There is no financial penalty in 2014 specifically tied to not reporting Measure #44. However, not reporting Measure #44 may deprive an eligible professional of the .5% PQRS incentive payment, paid in 2015. It’s also worth noting that 2014 is the last year a PQRS incentive payment will be offered.
Calendar year 2014 is the reporting period for the 2016 PQRS payment penalty, which is 2%. To avoid the 2016 PQRS payment penalty, an eligible professional an report at least 3 measures covering one National Quality Strategy (NQS) domain for at least 50% of their Medicare Part B FFS patients seen during the reporting period to which the measure applies. An eligible professional that reports fewer than 3 measures covering at least 1 NQS domain will be subject to the Measure Applicability Validation process, which will allow CMS to determine whether additional measures or domains should have been reported. Those that report satisfactorily for the 2014 reporting period and receive an incentive will also avoid the 2016 PQRS payment penalty.
abeo anticipates additional PQRS reporting measures to be included by CMS in the future. Our job as an anesthesia billing and practice management company is to help our eligible clients follow the rules set forth by CMS so they can appropriately avoid unnecessary penalties and earn indicated incentives. abeo is an Anesthesia Quality Institute (AQI) Preferred Vendor.
Clients may contact their Client Manager for further interpretation on Measure #44 and abeo’s recommended modifications to your practice’s reporting mechanism.
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Identification of CABG cases for patients 18 years or older who received a beta-blocker within 24 hours prior to incision. Applies to cases with the following ASA/CPT Codes:
Patients aged ≥ 18 years on date of encounter
AND Patient encounter during the reporting period (CPT): 00566, 00567, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
Patient encounter during the reporting period (CPT): 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
AND Patient encounter during the reportin period (CPT): 00562, 33530
The physician will need to appropriately indicate the numerator from the selection below:
CPT II 4115F: Beta blocker administered within 24 hours prior to surgical incision
OR Preoperative Beta-blocker not Administered for Documented Medical Reasons Append a modifier (1P) to the CPT Category II code 4115F to report documented circumstances that appropriately exclude patients from the denominator. 4115F with 1P: Documentation of medical reason(s) for not administering beta blocker within 24 hours prior to surgical incision (eg, not indicated, contraindicated, other medical reason)
OR Preoperative Beta-blocker not Received, Reason not Otherwise Specified: Append a reporting modifier (8P) to CPT Category II code 4115F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. 4115F with 8P: Beta blocker not administered within 24 hours prior to surgical incision, reason not otherwise specified
abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.