PQRS

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Client Profile:

A Mid-Atlantic Physician Billing Office responsible for management and reporting of billing-related and revenue impacting functions for employed physicians of several local hospital centers 

Challenge:

PQRS is a Medicare sponsored punitive quality program, requiring providers to report quality measures to assess the quality of care they provide to their patients, the rules of which were unfamiliar to most in the healthcare community. 

The client requested a summary of the program requirements, provider education, and guidance in establishing a compliance program to reduce or eliminate financial risk for all impacted providers.

i3 partnered with subject matter experts to facilitate a three-phase approach:

• Phase One: Survey and Assessment of risk for all impacted parties
• Phase Two:  Recommendations for program compliance for current and future calendar years
• Phase Three:  Support and Implementation of recommendations

Key tasks included identifying a vendor to serve as a registry submission vendor, creation of infrastructure to support quality data submission, identification and education of site specific key contacts, creation of policy and procedure, and monitoring initial program implementation results.

The implementation of the PQRS Data submission program had the desired result of avoiding financial penalties for all relevant providers during the current and subsequent calendar years.  Additionally, the program was successfully transitioned to the client for ongoing management by providing education and training to the client’s team members.