PQRS: IT'S NOT TOO LATE TO REPORT
AUGUST 25, 2016
MDinTouch has compiled this guide to assist Practice Fusion EHR Providers with their 2016 Physician Quality Reporting System (PQRS) reporting.
There are three reporting methods available for PQRS.
- Claims Reporting: This method is free but you would have needed to start in January for reporting on 50% of your Medicare patients. A major disadvantage is that once you submit a claim, you cannot retroactively add measure codes. There are measure groups allowing you to only report on 20 patients for 2016 and this is the method we will review in this guide.
- Qualified Registry: Your Provider would have to choose a Medicare approved registry, which submits the measure codes on their behalf.
- Electronic Reporting via CEHRT (Certified EHR Technology).
Don’t Get Penalized!
The measures reported in 2016 are rolled into an Incentive Payment System for the year 2018. A Provider can have a negative, positive or neutral adjustment.
We will not cover adjustments in this guide. For more information, please see the following CMS link to understand how these adjustments work:
In this guide we will describe the Preventative Measure Group Codes that you can use for reporting on 20 of your Medicare patients. Please follow the steps below and complete all measures listed to report on your superbills. These codes only pertain to Medicare, Railroad Medicare and Medicare Secondary encounters. This does not pertain to Medicare Managed plans.
You will need to choose 20 Medicare patients and submit these codes. These encounters need to be current. PQRS codes cannot be added to previously submitted claims.
Claims Based Reporting is currently the only method supported by Practice Fusion for the Preventative Care Measures Group.
As an overview, MDinTouch suggests the following. The provider chooses 20 unique Medicare Part B FFS (fee for service) patients aged 50 and older that come in for any of the following:
- 99201, 99202, 99203, 99204, 99205
- 99212, 99213, 99214, 99215
as the patient sample.
For the first patient in the sample a one time Intent to Report code must be submitted:
- Submit G8486
For each of the 20 patients in the sample, perform:
- #110 Influenza Immunization: Submit G8482 or G8483
- #112 Screening Mammography: Submit 3014F with 8P
- #113 Colorectal Cancer Screening: Submit 3017F with 8P
- #128 Body Mass Index (BMI) Screening and Follow-Up: Submit G8420,G8417 or G8418
- #134 Screening for Clinical Depression and Follow-Up Plan: SubmitG8431 or G8510
- #226 Tobacco Use: Screening and Cessation Intervention: Submit 4004For 1036F
- #431 Unhealthy Alcohol Use: Screening & Brief Counseling: Submit 3016 with 1P
For each patient 65 and older in the sample, perform:
- #111 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 years and Older: Submit 4040F or 4040F with 8P
For each female patient 65-85 years of age in the sample, perform:
- #39 Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older: Submit G8399 or G8401
For each female patient 65 and older in the sample, perform:
- #48 Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older: Submit 1090F or1090F with 1P
#110 - Influenza Immunization
Influenza Immunization Screening : Patients that received an influenza immunization OR who reported previous receipt of an influenza immunization.
Track Influenza in Immunization (Go to: Immunization , Historical )
If administered or previously received: G8482
Immunization was not administered for reasons documented (vaccine not available): G8483
#112 Screening Mammography
Screening Mammography: Female patients that had Mammogram to screen for breast cancer within 27 months.
Screening results documented and reviewed: 3014F
Documentation of medical reason(s) for note performing screening: 3014F with 1P
Screening results not documented and reviewed: 3014F with 8P
#113 Colorectal Cancer Screening:
Colorectal Cancer Screening: Patients who had appropriate screening for colorectal cancer.
Screening results documented and reviewed: 3017F
Documentation of medical reason(s) for note performing screening: 3017F with 1P
Screening results not documented and reviewed: 3017F with 8P
#128 Body Mass Index (BMI) Screening and Follow-Up
Body Mass Index (BMI) Screening and Follow-up. Track those patients with BMI outside normal parameters.
Age 65 years and older BMI ? 23 and < 30 kg/m2
Age 18 – 64 years BMI ? 18.5 and < 25 kg/m2
Dr documents follow-up plan in note i.e.: “Patient referred to nutrition counseling for BMI above normal parameters.”
BMI documented within normal parameters: G8420
BMI documented above normal parameters and follow-up documented: G8417
BMI documented above normal parameters and follow-up documented: G8418
#134 Screening for Clinical Depression and Follow-Up Plan
Screening for Clinical Depression and Follow-up plan:
If Patient has depression, Dr. records reference due to positive depression screening in note and follow-up documented, i.e. “Patient referred for psychiatric evaluation due to positive depression screening.”
Screening documented positive and follow-up plan documented: G8431
Screening documented negative: G8510
#226 Tobacco Use: Screening and Cessation Intervention
Tobacco Use: Screening and Cessation Intervention. If Positive patient needs briefing
Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user: 4004F
Current tobacco non-user: 1036F
#431 Unhealthy Alcohol Use - Screening & Brief Counseling
Patient must be screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND receive brief counseling if identified as an unhealthy alcohol user.
Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling:G9621
Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method: G9622
Measures - For Patient 65 and Older
#39 Screening or Therapy for Osteoporosis for Women Aged 65-85 Years of Age
Female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis.
Patient with documented results of a central Dualenergy X-Ray Absorptiometry (DXA) ever being performed: G8399
Clinician documented that patient was not an eligible candidate for screening or therapy: G8401
#48 Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older
Patients who were assessed for the presence or absence of urinary incontinencewithin 12 months.
Presence or absence of urinary incontinence assessed: 1090F
Documentation of medical reason(s) for not assessing for the presence or absence of urinary incontinence: 1090F with 1P
#111 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 years and Older
Patients who have ever received a pneumococcal vaccination
Pneumococcal vaccine administered or previously received: 4040F
Pneumococcal vaccine was not administered or previously received, reason not otherwise specified: 4040F with 8P
Patient records must document that all the measures were done. The following is a suggested template for documentation for each of the 20 patients chosen for the measures group.
She also had PQRS preventative care measures screening performed today. Patient reports obtaining influenza immunization one month ago. Screening for mammography was also performed 2 weeks ago was noted to be negative. She had colorectal cancer screening 2 years ago via colonoscopy, which was also reported to be negative. Body mass index screening was noted to be within normal parameters. She was provided with nutritional counseling today. Screening the clinical depression, as well as unhealthy alcohol use is noted to be negative. She is a non-tobacco user. Patient has also been screened two weeks ago for osteoporosis the results are pending at this time. Counseling was provided for osteoporosis. Screening for urinary incontinence was noted to be negative. Patient reports obtaining a pneumococcal vaccination one month ago. Further recommendations will follow.