ZirMed’s Latest Update Streamlines Workflow for “Pay For Performance”

ZirMed is a Louisville, Kentucky-based provider of revenue cycle management solutions. Its solutions have keep pace with healthcare’s changing fundamentals –from reimbursement, to patient payment and across all the required business applications that optimize the related workflows. By adding functionality on a timely basis and continuously improving its interoperability and implementation efficiencies, the company has continued to grow nicely.

Today, ZirMed announced a significant update to its 2013 Physician Quality Reporting System (PQRS) solution. As part of the company’s Claims Management Suite, the enhancement offers providers a CMS-compliant PQRS reporting solution that allows providers to submit individual patient quality data with confidence they’ll receive their incentive payments under the 2013 Medicare Part B – 0.5% incentive payment program.

All the way back in 2007, CMS took its first step towards “pay for performance” reimbursements by launching the Physician Quality Reporting Initiative (PQRI).  Since its introduction, CMS has paid bonus payments to the hundreds of thousands of providers who have begun reporting information used to evaluate patient outcomes and assess the quality of care delivered. ZirMed’s latest solution enhancements enable providers to determine which CMS quality measure codes are most relevant for their practice and allows them to construct a quality measuring and reporting program.

In addition, the solution will scrub outgoing Medicare claims and alert the submitter each time quality measures are not reported. The system will return the claims to the provider seeking the additional required information. Flagging the claim and returning it to the provider is a critical precautionary step in maintaining compliance with the 50% reporting requirement against quality measures for qualified Medicare claims.  ZirMed’s smart coding tool offers providers the comfort of knowing an inspection instrument will review each Medicare claim before it is submitted.

  • To qualify for the bonus, providers must report on at least 3 PQRS measures and include PQRS quality data on 50% of the claims that qualify for each measure. Currently, the PQRS bonus payments are based exclusively on participation and successful reporting rather than on the performance indicated by the PQRS measures. Even if a provider reports a negative outcome for each qualifying patient, he or she will still earn the participation bonus if quality data has been submitted on at least 50% of the qualifying claims. Therefore, it is the act of reporting itself, and not the quality of care indicated by the reporting, that determines whether a provider will meet the requirements for earning the PQRS bonus.

Those providers who do not participate in 2013, will not only miss out on incentive payments, but will incur penalties starting in 2015.

Source: ZirMed Press Announcement

—Tom Finn

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