News Feature | March 27, 2014

CMS To Collect Improper Payments Made Through PQRS

Rebecca McCurry

By Rebecca McCurry

PQRS Imrpoper Payments Collection By CMS

CMS plans on recovering payments that were improperly made through the Physician Quality Reporting System and Electronic Prescribing Incentive

According to Federal Register, CMS wants to recover improper eRx payments because , "The incentive and reporting programs have data integrity issues, such as rejected and improper payments. This four year project will evaluate incentive payment information for accuracy and identify improper payments, with the goal of recovering these payments. Additionally, based on the project's results, recommendations will be made so that we can avoid future data integrity issues."

The report also explains, "Data submission, processing, and reporting will be analyzed for potential errors, inconsistencies, and gaps that are related to data handling, program requirements, and clinical quality measure specifications of PQRS and eRx program. Surveys of Group Practices, Registries, and Data Submission Vendors (DSVs) will be conducted in order to evaluate the PQRS and eRx Incentive Program."

FierceHealthIT explains CMS will survey around 400 group practices, as well as registries and vendors, on an annual basis. They will also interview some about these programs. "Adoption of e-prescribing continues to grow through the federal incentive programs. In 2012, about 69 percent of physicians used e-prescribing. A record 788 million prescriptions (44 percent) were routed electronically in 2012, up from 570 million (36 percent) in 2011." The article also explains that the public will be able to comment on this notice for the next 60 days, with the comment period ending on May 16th.

E-Prescribing has proven to be extremely beneficial to those that use it. In New York, there is a database that "tracks the disbursement of prescription drugs." FierceHealthIT discusses that this program "has helped the state slash incidences of doctor shopping by 75 percent." The article explains "more than 66,000 healthcare professionals across the state have fun more than 7 million individual prescription checks on close to 3 million separate patients since last August. The law requires that provides e-prescribe all drugs by March 2015."

According to an announcement, "In March 2015, I-STOP will make New York one of the first states to schedule the universal mandate of e-prescribing for all drugs. This system will nearly eliminate the problem of forged, traded, or stolen prescriptions—used both by addicts and criminal organizations to obtain a wide variety of pills to resell on the street and on the black market. These crimes also cost the taxpayers millions."