PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jopHomeThis ArticleASCO JOPSearchSubmitASCO JOP Homepage
 
J Oncol Pract. 2008 March; 4(2): 66–67.
PMCID: PMC2793973

The CMS Physician Quality Reporting Initiative

The Centers for Medicare & Medicaid Services' (CMS) Physician Quality Reporting Initiative (PQRI) was extended for 2008 and took effect January 2, 2008. Changes to the initiative for 2008 include an increase in the number of quality measures and coding changes within many of the measures themselves. Like the 2007 PQRI program, the initiative in 2008 establishes a financial incentive for participation. Providers who meet the requirements for the 2008 program will be eligible for a bonus payment of 1.5%, which is based on the total allowed charges paid under the Physician Fee Schedule. Some of the 2007 oncology-related measures will be used again in 2008; however, the specific codes used to report the measures and the reporting specifications themselves may have changed.

CMS published a total of 119 quality reporting measures for 2008. The oncology-related quality measures that may be of interest are listed in Table 1.

Table 1.
Selected Quality Reporting Measures for 2008 Reported by CMS

There are also a number of general measures that oncologists may be interested in reporting. While other measures may also be applicable to your practice, some of the general measures are listed in Table 2.

Table 2.
Selected General Quality Reporting Measures for 2008

All 119 PQRI measures can be viewed at CMS' Web site(www.cms.hhs.gov/pqri). The American Medical Association created worksheets that can be used to assist providers in reporting the quality measures. The oncology-related measures listed here are detailed in ASCO's 2008 PQRI Measures for Consideration by Oncology Providers (www.asco.org/pqri).

NOTE. The specific codes used to report the measures and the reporting specifications themselves may have changed between 2007 and 2008. For example measures 71, 72, and 73 have undergone a number of significant specification and coding changes. If you are planning to report these codes, make sure to review the new specifications and coding requirements carefully.

Notable Changes in the 2008 Medicare Hospital Outpatient Payment System That Affect Oncologists

  • When billing for drug administration services in the hospital outpatient setting, Medicare requires the use of the 2008 Current Procedural Terminology© (CPT) codes. New language appears in the 2008 CPT manual to assist hospitals in reporting drug administration services and clarify hospital reporting versus physician reporting.
  • CMS has increased the threshold for packaging of drugs. In 2008, drugs that cost less than US $60 will be bundled into the administration service. This rule, however, does not apply to antiemetic drugs, which are reimbursed separately regardless of their daily cost.
  • CMS decided to continue the extra payment for preadministration services related to the administration of intravenous immune globulin; therefore, G-code G0332 will continue to be a payable service by Medicare in 2008. However, the payment rate in the hospital has decreased by approximately half.
  • The general payment rate for drugs in 2007 was ASP + 6%; however, that rate was changed to ASP + 5% for 2008. (This excludes new drugs, drugs that are bundled into the administration service, and radiopharmaceuticals.)

New Smoking Cessation Codes

There are two new Current Procedural Terminology codes in 2008 for smoking cessation counseling. The two new codes, 99406 (smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes) and 99407 (smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes), are categorized as evaluation and management services and are considered face-to-face services. Codes 99406 and 99407 replace Medicare G-codes G0375 and G0376. The new codes are payable services by Medicare and the payment rate is approximately US $11.93 and $23.52. (Payment rate is based on the 2008 practice expense transitional value, a geographic practice cost index of 1.00, and a conversion factor of $34.09.) These codes are distinct from evaluation and management (E/M) services that may be reported separately when performed. Any E/M services reported on the same day must be distinct, and time spent providing counseling services may not be used as a basis for the E/M code selection.

Note. 2008 PQRI measures 114 and 115 relate to smoking cessation or the inquiry of tobacco use. Providers can consider PQRI measures 114 and 115 when performing a new or established patient visit as described in the measure specifications.


Articles from Journal of Oncology Practice are provided here courtesy of American Society of Clinical Oncology