Our Federal government keeps coming up with ideas to give all of us more money!!! At least that is what they claim. If you use certified Electronic Health Record (EHR) computer software and demonstrate meaningful use of that EHR, then you may qualify for up to $44,000.00 in bonus payments from Medicare. The bonus is NOT based on the cost of the EHR program. The amount of the bonus is determined by the amount of money Medicare pays you. Medicare sets the bonus at about 75% of what they normally pay you. So if your annual Medicare payment is only $1,000 you will get a bonus check for $750; if the payment is $25,000, your bonus check will be $18,000. Should you qualify for the maximum bonus each year for 3 years in a row, your bonus checks will total $44,000.
In order to demonstrate meaningful use of your EHR system, you must utilize the Physicians Quality Reporting System (PQRS) codes. And according to the government, any doctor that uses the PQRS codes correctly will have his/her payments increased by 2%. This means that for every $100 you would normally receive from Medicare, you will get a total of $102 by using PQRS. It may not be a lot, but it is better in your pocket than staying with the government.
PQRS consists of codes that most of us have never heard of. There are CPT I codes, CPT II codes and G-codes. And each code must match up with something else on the claim form. That something else may be an ICD-9 code, a regular CPT service code, and/or some aspect of the patient’s demographics. Each PQRS code must have only one diagnosis pointer. And when PQRS is used, your CMS1500 must be completed in a very specific manner.
In order to demonstrate meaningful use of your EHR system, you must utilize the Physicians Quality Reporting Initiative.
The good news is that PQRS is being automated in some EHR systems. This programming development provides you with the benefits of PQRS without having to master every aspect of its technical requirements. However, you should make it a point to understand the concepts behind PQRS so that you will be able to respond to claims examiners or auditors when asked why you used it.
An example of the PQRS codes shows what needs to be reported regarding back pain. Back Pain Measures Group consists of 4 measure specifications:
1. PQRI measure #148 back pain initial visit–includes pain assessment, functional status (assessment form in patient file, signed by patient), history noting presence/absence warning signs, assessment of prior treatment and response, and employment status. Use CPT II code 1130F. The pain assessment and functional status should be completed by the patient using standard functional assessment forms such as Oswestry, Rand, Pain Disability Questionnaire, etc. Note that Medicare requires proof that the patient completed the form, so the patient’s signature MUST appear verifying that he/she answered each question and completed the form.
2. PQRI measure #149 back pain physical exam–straight leg raise test and a neurovascular exam showing presence/absence of findings. Be sure to note all positives and negatives. If you only record positive findings and do not record the negatives, an auditor will claim that you made a false or fraudulent claim. Use CPT II code 2040F.
3. PQRI measure #150 back pain advice for normal activities–advice to maintain or return to normal activities. Use CPT II code 4245F.
4. PQRI measure #151 back pain advice against bed rest–patient counseled against bed rest of 4 days or longer. Use CPT II code 4248F.
If ALL these items are to be reported, then a single composite G-code G8502 can be used. Note that PQRI codes must be reported correctly. If errors are made, you do not have the ability to correct them and simply loose the benefits of PQRI.
Currently there are 179 PQRS codes. It is incumbent on you to go through the list and see which ones apply to your practice. Make sure those items are in your EHR system. It is critical that you look up each code individually and know when it should/should not be used. Keep in mind that the PQRS codes are evaluated and revised every year, so from one year to the next you may need to revise your list.
Various software companies are passing the tests and getting their EHR systems certified.
The government has authorized 3 companies to test and certify EHR software. Many EHR programs are passing the tests and getting certified. The overwhelming majority are medical systems. There are a few Chiropractic specific EHR systems that received certification in November 2010. Only a handful of Chiropractic specific software companies qualified for certification before the end of 2010. And you had to have certified EHR in place before the end of 2010 to qualify for the Medicare stimulus calculation beginning in January 2011. Otherwise, the earliest you can qualify for the stimulus bonus is April 2011. So if you are planning on getting EHR computer software for your practice, find out if the system you are looking at is certified or will soon have certification. If it is not, then select another software program that is or will soon be certified.
Using PQRS is the tool that demonstrates meaningful use, and therefore qualifies you for up to $44,000.00 in bonus payments. It also gives you a 2% bonus just for using PQRS.
Make sure that you get the greatest amount of payment from the government that you possibly can. This will be one of the rare occasions when you will be able to recoup some of the money you paid to the tax man.
Dr. Paul Bindell, a 1975 Palmer graduate, has been in practice in Rockaway, NJ, since 1976. He lectured on Chiropractic in Brazil and Israel and is a past Chairman of Public Relations for the Northern (NJ) Counties Chiropractic Society. The Chiropractic Answer produced by Dr. Bindell in the 1980’s was a cable television program, a newsletter, and a newspaper column. In 1991, Dr. Bindell and his family began Life Systems Software so Chiropractors would have computer programs based on real practice. As a consultant, Dr Bindell is the expert in assisting the profession and individual Chiropractors to improve and succeed. Numerous articles have been written by Dr. Bindell and have appeared in several Chiropractic journals. Dr. Bindell is available to speak to your group or organization and can be reached by email at
, or you can call Life Systems Software at 1-800-543-3001.