Billers: Medicare PQRS Participation Not Worth the Effort

Proposed changes to Medicare's Physician Quality Reporting System do little to encourage physician practices that outsource their billing to start participating in the incentive-for-quality-reporting program, according to the Healthcare Billing and Management Association.

In comments to the Centers for Medicare and Medicaid Services on the proposed Medicare Physician Fee Schedule rule published in July, the association noted that only a small percentage of practices that outsource billing participate, largely for financial reasons. "Specifically, the bonus payments are less than the additional cost of submitting the data, even when the billing company imposes no additional fee for providing their support of PQRS participation," according to HBMA.

Further, association members who did participate found that "despite diligent (and verifiable) submission of data, bonus payments were either not received at all or were for amounts that were significantly smaller than their data projected."

Future payment reductions for non-participation could result in practices partially or completing abandoning the treatment of Medicare patients, the association contends. "These experiences have left many in our industry highly disappointed, as well as skeptical of the integrity of the program. When asked by clients about possible participation, our members feel, reluctantly, obliged to truthfully report on their actual experiences and caution practices about the economic and operational value of additional work associated with this program."

The association also has concerns about general cuts in reimbursement, bundled payments and limitations on submitting data via registries or electronic health records systems. The comment letter is available here.