News Feature | October 8, 2013

Contractor To Recover Improper Bonuses Paid For Incentive Program

Source: Health IT Outcomes
Greg Bengel

By Greg Bengel, contributing writer


Medicare hires Arch Systems to verify the accuracy of provider data submitted to the Electronic Prescribing Incentive Program (eRx) and Physician Quality Reporting System (PQRS)

By Greg Bengel, contributing writer

Providers beware, a new contractor has been charged by Medicare to recover improper bonuses paid to physicians for quality reporting and electronic prescribing efforts.

According to Ob.Gyn. News, Arch Systems of Baltimore, under a $9.9 million dollar contract, will be checking the accuracy of data submitted to the Electronic Prescribing Incentive Program (eRx) and Physician Quality Reporting System (PQRS), in an effort to recover money paid to doctors who are “gaming” the incentive programs. Data submitted in the claims-based reporting option may also be reviewed in later audits.

According to the article, 2011 saw 266,521 eligible professionals earning PQRS incentives that averaged $1,059 and totaled $240.4 million. Also in that year, approximately $270 million in eRx bonuses were paid to 174,189 providers. When it came to PQRS, almost 63,000 providers used registries, while only 92 practices sent data through the group practice reporting option.

“Since the inception of the PQRS and eRx incentive programs, there have been reports uncovering data-integrity issues and misunderstandings regarding data submissions, and suspicious attempts of ‘gaming’ the system to earn the PQRS and/or eRx incentive payment,” the article quotes from CMS documents. “Despite extensive education and outreach efforts, mandatory support calls, and special training sessions, these data issues persist.”

The article also points out that some providers are concerned that this program will be similar to the recovery audit contractors program, which has recovered $5.4 billion from providers since October of 2009. As previously reported, RACs have been accused repeatedly of burdening legitimate providers by denying legitimate claims, so much so that they have been labeled “bounty hunters” by at least one provider. In the Ob.Gyn. News article, this concern is raised by Dr. Richard Duszak Jr., radiologist and chief medical officer of the Harvey L. Neiman Health Policy Institute at the American College of Radiology.

Duszak says that he is unaware of instances of fraudulent reporting, and that in fact, physicians actually struggle with identifying clinical encounters that could be reported for quality measures.

CMS, however, would disagree. According to the article, “The data have been validated once already, CMS spokesperson Don McLeod said in an interview. During these checks, the agency discovered issues in which information submitted by eligible providers did not match data in the agency’s records.”