October 2013
The essential resource for your practice
Volume XXI, Number 10

Government Shutdown Update

With two weeks and counting on the Government shutdown, House and Senate leaders remain intransigent in their positions. In an effort to get certain government programs running again, the House GOP continues to offer “piece-meal” resolutions to fund specific programs (e.g., National Institutes of Health, veterans’ programs, national parks), yet the Senate majority has stated that they are not willing to accept piece-meal funding.  

Table of Contents


Coding Corner:

Practice Management Records ICD-10-CM Basic Training Course

PQRS Deadline for Admin Claims and Group Reporting Options Extended Until October 18

Eligible providers (EPs) who do not participate in the Physician Quality Reporting System (PQRS) in 2013 will incur a 1.5 percent Medicare payment adjustment (penalty) in 2015. For EPs who wish to avoid the payment adjustment but are not concerned with earning an incentive, participating in PQRS through Administrative Claims is an option. Through this option, the Centers for Medicare & Medicaid Services (CMS) will automatically analyze an EP’s Medicare claims on a pre-selected set of largely primary care-focused measures. The measures have little relevance to urology; so, one’s “score” will not be completely pertinent to a urology practice. However, an EP gets credit for PQRS participation and successfully avoids the payment adjustment.  Those choosing Administrative Claims must register with CMS, and CMS has just extended the deadline until Friday, October 18.

Additionally, in the Affordable Care Act, Congress requires CMS to apply a Value-Based Modifier (VBM) to all physicians’ Medicare payments by 2017 and to some physicians’ payment starting in 2015. In response, CMS intends to apply a 1 percent VBM penalty to the Medicare payments of physicians in groups of 100 or more that do not engage in GROUP participation in PQRS in 2013. This VBM penalty will be in addition to another 1.5 percent penalty that will apply to all physicians who do not participate in PQRS either as an individual or as part of a group. To avoid these penalties, physicians in groups of 100 or more should ensure that their GROUP is registered for one of the PQRS group participation options. This deadline was also extended until Friday, October 18.

For The Record

In order to qualify for incentive payments (or avoid penalties beginning 2015) under the Meaningful Use program, one of the key requirements is to use Electronic Health Records(EHR) software that is certified in accordance with standards of the Office of the National Coordinator for Health Information Technology. According to an article published in the electronic newsletter iHealthBeat (link removed), practices that will be expected to meet the Stage 2 Meaningful Use (MU) standards in 2014 may have far fewer certified systems to choose from.

Surgical Risk Calculator Can Help with Patient Counseling

The American College of Surgeons (ACS) has developed a risk calculator for surgical patients. Specifically, this tool is intended for non-emergency surgical patients and provides a preoperative risk assessment of postoperative complications. The calculation is based on specific patient data and encourages a personal discussion between the patient and physician about the risks associated with surgery.

The risk calculator can be used for a wide variety of surgical procedures, including urology, and is based on a validated, risk-adjusted statistical model predicting the 30-day postoperative complications for the specific procedure that patient is undergoing. Risk calculations are formulated based on preoperative patient-specific data, such as demographics (age, gender, race), relevant lifestyle and clinical risk factors (smoking status, body mass index), patient co-morbidities, procedure type, and procedure indication. Postoperative complications include 30-day risk adjusted mortality and 30-day risk-adjusted overall morbidity.