Guest guest Posted July 20, 2007 Report Share Posted July 20, 2007 No, HMO's are not in the PQRI program. Neither is Travelers Medicare. ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Gabe Freyaldenhoven Sent: Thursday, July 19, 2007 3:42 PM To: PTManager Subject: PQRI I am looking for some clarification on the PQRI. Should reporting of the PQRI be done if the patient is over 65, but has elected to have a medicare HMO or other " third party " Medicare. We had a patient with " Humana Gold " Medicare present today and we weren't sure if we should report the PQRI. As always, thanks for your input. Gabe Freyaldenhoven, PT River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 22, 2007 Report Share Posted July 22, 2007 HERE IS A LINK TO THE PAGE WITH TONS OF STUFF: •https://www.cms.hhs.gov/PQRI THERE IS A POWER POINT PRESENTATION AND OTHER STUFF IF YOU CLICK ON " EDUCATIONAL RESOURCES " ON THE LEFT SIDE OF THE PAGE. AND MODULE 1 GIVES THE BASICS. Cheri Freeman, CMRS Mountain View Physical Therapy > > Does anyone know where I can send therapists for info on the PQRI reporting guidelines? Is the PQRI initiative voluntary or mandatory? > Thanks > Amy McBreen-Babb, PT > FL > _____________________________________________________________________ ___ > AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2008 Report Share Posted January 17, 2008 For those of you doing the Medicare bonus payment system right now: If you have a patient that has non-traditional Medicare(Humana Gold, Secure Horizons), should we be including them in the PQRI reporting. Will they be included when determining the 80% threshold? I have been looking for a mention of this in the PQRI stuff Medicare is putting out, but haven't seen it. Thanks for your help. Gabe Freyaldenhoven, PT River Valley Therapy and Sports Medicine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2008 Report Share Posted January 17, 2008 Gabe, I have noticed that those companies you noted do not allow the codes to be billed. We still take the information and write it manually on our superbills and keep the questionnaires in our charts. We do that in the event of some type of audit there is a paper trail that can be followed and, more importantly for me personally, we get used to doing these questionnaires with the medicare population patients no matter their separate company representative. Lane Blondheim, PT, MT Active Health and Rehab Montgomery, AL -- In PTManager , " Gabe Freyaldenhoven " wrote: > > For those of you doing the Medicare bonus payment system right now: If you > have a patient that has non-traditional Medicare(Humana Gold, Secure > Horizons), should we be including them in the PQRI reporting. Will they be > included when determining the 80% threshold? I have been looking for a > mention of this in the PQRI stuff Medicare is putting out, but haven't seen > it. > Thanks for your help. > Gabe Freyaldenhoven, PT > River Valley Therapy and Sports Medicine > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2008 Report Share Posted January 20, 2008 Jeff, Thanks for the information on PQRI. I am currently trying to convince the office staff of this and am looking for what you've said below in any of the transmittals. Can you point me to the transmittal where you saw this? Thanks for the info Gabe Freyaldenhoven, PT River Valley Therapy and Sports Medicine From: PTManager [mailto:PTManager ] On Behalf Of ptbug2 Sent: Friday, January 18, 2008 8:04 AM To: PTManager Subject: Re: PQRI Only patients with Medicare are included in the PQRI. Patients with Managed medicare products are not. Patients with these payers you have mentioned are for all intents and purposes commercial insurance patients. Jeff Weil, PT Raleigh, NC > > For those of you doing the Medicare bonus payment system right now: If you > have a patient that has non-traditional Medicare(Humana Gold, Secure > Horizons), should we be including them in the PQRI reporting. Will they be > included when determining the 80% threshold? I have been looking for a > mention of this in the PQRI stuff Medicare is putting out, but haven't seen > it. > Thanks for your help. > Gabe Freyaldenhoven, PT > River Valley Therapy and Sports Medicine > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2008 Report Share Posted January 21, 2008 Gabe, I loath those transmittals but it is simple and let me know if this answers the question. PQRI is a program managed through CMS or some derivation of them. If the patient has for example Secure Horizons that patient is not receiving his/her benfits through Medicare but rather through Secure Horizons, a unit of United Healthcare. Therefore Medicare will not be paying that claim and thus that patient and your visits with him/her are not eligble for PQRI. In the simplest terms that patient is not a Medicare patient, but rather a Secure Horizons patient, in terms of benfits. Hopefully that helps. Regards, Jeff Weil, PT Raleigh, NC > > > > For those of you doing the Medicare bonus payment system right now: > If you > > have a patient that has non-traditional Medicare(Humana Gold, Secure > > Horizons), should we be including them in the PQRI reporting. Will > they be > > included when determining the 80% threshold? I have been looking for a > > mention of this in the PQRI stuff Medicare is putting out, but > haven't seen > > it. > > Thanks for your help. > > Gabe Freyaldenhoven, PT > > River Valley Therapy and Sports Medicine > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.