WATERTOWN, MA – athenahealth, Inc. has jumped into the pay-for-performance pool with both feet, announcing in March that its Web-based athenaNet practice management system includes physician quality measures and coding rules for its entire national client base.
Established in the Tax Relief and Health Care Act of 2006, the Physician Quality Reporting Initiative (PQRI) will be overseen by the Centers for Medicare and Medicaid Services. Providers who successfully report quality measure data on claims and services between July 1 and December 31 of this year will be eligible for a single consolidated incentive payment, equivalent to 1.5 percent of total allowed charges for covered physician fee schedule services provided during the time period.
“Medicare’s new pay-for-performance (P4P) program is the latest in what will be many other national or regional programs requiring physicians to accurately report performance data for increased revenue,” said Jonathan Bush, chairman and CEO of athenahealth, in a press release. “The P4P trend in healthcare only reinforces the need for providers to leverage a flexible service offering like athenahealth’s that combines intuitive software, continuously updated payer knowledge, along with billing specialists to optimize practical management and revenue.”
Participating physicians can capture data about the quality of care provided to Medicare beneficiaries along a set of 74 distinct measures. The measures are based on a combination of diagnosis and procedure codes but may include other factors, such as a patient’s age. Company officials say athenahealth has built proactive “Medicare PQRI Rules” that are independent of each other, allowing medical practices to select applicable measures.
The company is also adding measures related to ophthalmology and stroke/rehabilitation, with more planned. Administrative reports, displaying charge and amount information associated with PQRI claims, will be made available prior to the “go live” period in July.