PQRI and e-prescribing Made Simple
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1 NOA 3 rd PARTY WEBINAR PQRI and e-prescribing e Made Simple Dr. Quentin Quack presenting 1
2 PQRI Physician Quality Reporting Initiative Medicare Pay for Performance Voluntary for % Bonus Mandatory July 2012 (penalty w/o use) Start Now to eliminate bugs & snafus (office procedures, insurance personnel, software, claims clearinghouse, Medicare carrier) 2
3 PQRI Physician Quality Reporting Initiative 153 measures for measures dealing with eye care (1 measure only for surgeons) No need to register; just start coding PQRI measures 3
4 PQRI Physician Quality Reporting Initiative 4
5 NOA PQRI Traffic Sheet: pages 5 and 6 of the January rd Party Newsletter (separate sheet for copying) 5
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9 PQRI Modifiers 1P exclusion modifier due to medical reasons Examples include: not indicated (already received/performed); contraindicated (patient allergic history, potential adverse drug interaction) 2P exclusion modifier due to patient reasons Examples include: patient declined; economic, social, or religious reasons 3P exclusion modifier due to system reasons Reasons attributable to health care delivery system. Examples include: resources to perform the services not available; insurance or coverage/payer-related limitations 8P action not performed, reason not otherwise specified Eligible professionals can use the 8P modifier to receive credit for successful reporting but will not receive credit for performance. 9
10 more 10
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15 more 15
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18 Everything that you code must be DOCUMENTED in the patient record 18
19 At least 3 measures, 80% of time to count AOA & Dr. Quack recommendation: Submit for all reportable cases Frequent reporting will aid in meeting the 80% goal No penalty for more frequent reporting 19
20 Additional 2009 Measures That May Be Reported By Optometrists DISREGARD Measure 114 Inquiry Regarding Tobacco Use Measure 115 Advising Smokers to Quit HIT Measure 124-EHR Adoption/Use of Health Information Technology (Electronic Health Records_ Measure 128 Universal Weight Screening (BMI) and Follow-up Measure 130-Meds Universal Documentation and Verification of Current Medications in the Medical Record 20
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22 e-prescribing - NOW SEPARATE No longer under PQRI, but an independent 2% bonus. Should be reported on EVERY Medicare patient visit. To receive bonus, must report at least 50% No need to register, just start reporting 22
23 e-prescribing There are two types of e-prescribing systems: e-prescribing only (a "stand-alone" system), or electronic health record (EHR) systems with e-prescribing functionality. 23
24 e-prescribing Either may be used as long as they are able to do the following: 1. Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available). 2. Select medications, 3. Transmit prescriptions electronically using the applicable standards (includes fax), and 4. Warn the prescriber of possible undesirable or unsafe situations, drug interactions. 24
25 e-prescribing 5. Provide information on alternative meds, lower-cost, therapeutically appropriate alternatives (tiered formulary information, if available, meets this requirement see next item). 6. Provide information on formulary or tiered formulary medications, 7. Patient eligibility, and 8. Authorization requirements received electronically from the patient's drug plan. 25
26 e-prescribing Many of the systems now used in optometric practices, while referred to as e-prescribing systems, are actually computer-generated fax systems CMS is temporarily extending an exemption that will allow prescriptions to pharmacies via computer-generated faxes 26
27 e-prescribing MUST BE DONE ON EVERY MEDICARE PATIENT Example code plus one of the following G8443 if electronic drug order. G8445 if no prescriptions were ordered. G8446 if drug orders could not be made electronically pharmacy limitations, federal or state restrictions (narcotics), or patient preference 27
28 e-prescribing More information in January and February 3 rd Party Newsletter Free stand alone Software Available Google NEPSI Google ALLSCRIPTS 28
29 Google NEPSI 29
30 Google ALLSCRIPTS 30
31 e-prescribing Are ready to prescribe? Take the e-prescribing readiness assessment at 31
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