Physician Quality Reporting Initiative:
CMS Provides Opportunity to Test Your Reporting Capabilities

(PYA Alert dated May 23, 2007)


You are in good company. After many months of planning, physician practices are wondering if all of their hard work preparing for Medicare’s PQRI program will translate into reimbursement dollars in 2007 and into 2008. By now, you probably know which, and how many, of the 74 measures apply to your providers. Hopefully, you have familiarized yourself with the CPT Category II codes and/or G-codes required for reporting each measure. The final quality measures for the 2007 reporting period of July 1, 2007 through December 31, 2007 can be located on the internet at www.cms.hhs.gov/PQRI.

Now you need to know if you can successfully report the appropriate quality codes to your Medicare carrier. For those professionals interested in testing their billing system, CMS is providing a free of charge method with which to do so. CMS has designated HCPCS code “G8300” as a test code for PQRI reporting prior to the July 1, 2007 start date. According to CMS, “G8300” was formerly used in the 2006 PVRP program and will be retired on July 1, 2007. According to CMS, G8300 will be rejected on any claims submitted for dates of service on and after July 1, 2007. For testing purposes, providers may report G8300 on the CMS 1500 Form in field 24D. On the ASC X12N health care claim transaction (version 4010A1), practices may report G8300 in the SV101-2 “Product/Service ID” Data Element on the SV1 “Professional Service” Segment of the 2400 “Service Line” Loop.

Check your EOB to assure the test code has been passed through and processed by the carrier. You should see Claim Adjustment Reason Code message 96, “Non-covered charge(s)” along with Remark Code message N365, “This procedure code is not payable. It is for reporting/information purposes only.” The EOB will also indicate if a test code was denied, giving your practice the opportunity to resolve any problems. The EOB will serve as your feedback for the test. CMS will not issue any other feedback correspondence.

Please contact Jackie Anderson at (800) 270-9629 for additional details.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

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