What doctors of optometry need to know about Physician Compare

Physician Compare: What doctors of optometry need to know

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D. From the July/August 2016 edition of AOA Focus, page 44-45.

The overwhelming majority of doctors of optometry participate in the Physician Quality Reporting System (PQRS) through claims-based reporting. It's critical that doctors are aware that their participation in PQRS goes beyond just entering codes on a claim form and avoiding payment penalties.

Doctors of optometry should understand what information regarding the care provided to their patients is made public now and what CMS plans for the future.

The Affordable Care Act (ACA) directed the Centers for Medicare & Medicaid Services (CMS) to create the Physician Compare website. The website is intended to provide useful information to patients about physicians and other health care professionals who take part in Medicare. CMS initially introduced Physician Compare in late 2010. The first version of Physician Compare included basic physician contact and specialty information as well as information regarding whether physicians, including doctors of optometry, participated in PQRS. Over the past several years, CMS has been working to include more data on Physician Compare, and all doctors should understand what information regarding the care provided to their patients is made public now and what CMS plans for the future.

Physician Compare currently includes information on board certification, education, group affiliations and Medicare assignment. Whether a doctor participated in PQRS is also noted along with performance on certain quality measures. CMS determines what quality measures to post publicly based on consumer testing and whether the doctor met the minimum sample size of 20 patients for the quality measure. Many doctors of optometry have information displayed on Physician Compare that relates to the PQRS quality measures for tobacco screening and high blood pressure screening. CMS plans to continue using Physician Compare to provide additional quality measurement information to the public.

In the future, once the Merit-based Incentive Payment System (MIPS) begins, CMS also plans to post information on Physician Compare regarding physician performance under MIPS. This information could be posted as early as 2019 based on 2017 performance scores.

The AOA recommends that all doctors visit the Physician Compare website to determine whether the practice information on the site is accurate and up to date. Doctors should also review the PQRS information that is available. If a doctor identifies an error, updates can be made by contacting the Physician Compare team or by making updates in the Medicare Provider Enrollment, Chain, and Ownership System. Doctors also should be aware of the 30-day review period for PQRS data before that information is made public. Look for notices from AOA and CMS regarding data review periods.

July 27, 2016

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