2016
Define PQRS Explain Who Should Participate Discuss the Process for PQRS Reporting Explain How Often Therapists Should Report
Physician Quality Reporting System A quality reporting system for Medicare B and Medicare Replacement Plan pts A combination of incentive payments and payment adjustments to the provider The provider will experience a negative payment adjustment for therapists who do not report on quality measures for patient care
Provider Physical Therapists Occupational Therapists Speech Language Pathologists Clinical Setting Carrier Billing Sites Therapist in Private Practice Carrier Billing Sites Therapist in Private Practice Carrier Billing Sites Therapist in Private Practice
Use Standardized Assessments associated with each PQRS Measure PT: 8 Measures / 6 if no Diabetes Dx REQUIRED OT: 10 Measures REQUIRED SLP: 3 Measures REQUIRED
#154 Falls - Risk Assessment Use Generic Fall Risk Assessment Tool #155 Falls - POC Document a POC for Falls if indicated Must document referral to physician for Vitamin D supplementation advice Must document Balance, Strength, Gait Training #182 Functional Outcome Assessment Document functional outcome using standardized, multidimensional tool: Neck Disability Index; DASH; SPADI; Upper Extremity Functional Index; Oswestry Disability Index; Roland Morris Questionnaire; Lower Extremity Functional Scale. #131 Pain Assessment and Follow-Up Use Visual Analog Pain Scale
#126 Diabetes Foot / Ankle Evaluation Documented eval should include: 10-g monofilament plus one of the following: vibration using 128 Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold #127 Diabetes Footwear Evaluation Foot exam documenting vascular, neurological, dermatological, and structural / biomechanical findings. Foot should be measured using standard measuring device, counseling on appropriate footwear should be based on risk category. #128 Body Mass Index (BMI) (Weight (lbs)/height (in) x Height (in))703 Example: (120 lbs/65 in x 65 in) 703 = 19.96 BMI
#130 Documentation of Current Medications in the Medical Record Document a current, complete, accurate list of medications in the medical record for the pt encounter. Documentation of medications in the medical record may include acknowledgment in the electronic health record that the medications have been reviewed and there are no changes, as indicated by the patient, or it may include a list documented in the progress note. This measure does not include a pharmacological assessment. Document all medications that patient is currently taking including: Prescriptions Over-the-Counter Drugs Herbals Vitamin / Mineral / Dietary / Nutritional Supplements
#154 Falls - Risk Assessment Use Generic Fall Risk Assessment Tool #155 Falls - POC Document a POC for Falls if indicated Must document referral to physician for Vitamin D supplementation advice Must document Balance, Strength, Gait Training #131 Pain Assessment and Follow-Up Use Visual Analog Pain Scale #182 Functional Outcomes Assessment Document functional outcome using standardized tool #431 Unhealthy Alcohol Use Screening and Counseling AUDIT(Alcohol Use Disorders Identification Test) Screening Tool
#130 Documentation of Current Medications in the Medical Record Document a current, complete, accurate list of medications in the medical record for the pt encounter. Documentation of medications in the medical record may include acknowledgment in the electronic health record that the medications have been reviewed and there are no changes, as indicated by the patient, or it may include a list documented in the progress note. This measure does not include a pharmacological assessment. Document all medications that patient is currently taking including: Prescriptions Over-the-Counter Drugs Herbals Vitamin / Mineral / Dietary / Nutritional Supplements
#128 Body Mass Index (BMI) (Weight (lbs)/height (in) x Height (in))703 Example: (120 lbs/65 in x 65 in) 703 = 19.96 BMI #226 Tobacco Use Screening & Cessation Intervention Ask about tobacco use, if positive, refer to physician for tobacco cessation intervention. #134 Screening for Clinical Depression & Follow Up Plan Use PHQ-2, if score greater than or equal to 3, refer to physician for assessment. #181 Elder Maltreatment Screen and Follow Up Use EASI (Elder Abuse Suspicion Index) if pt answers yes to any question 2-6 must include a documented report to state or local Adult Protective Services.
#131 Pain Assessment and Follow-Up Visual Analog Pain Scale A documented outline of care for a positive pain assessment is required. This must include a planned follow-up appointment or a referral, a notification to other care providers as applicable OR indicate the initial treatment plan is still in effect. These plans may include pharmacologic and/or educational interventions. #226 Tobacco Use Screening & Cessation Intervention Ask about tobacco use, if positive, refer to physician for tobacco cessation intervention
#130 Documentation of Current Medications in the Medical Record Measure #130 attests that the clinician made the best efforts to document a current, complete, and accurate list of medications in the medical record for the patient encounter. Documentation of medications in the medical record may include acknowledgment in the electronic health record that the medications have been reviewed and there are no changes, as indicated by the patient, or it may include a list documented in the progress note. This measure does not include a pharmacological assessment. Document all medications that patient is currently taking including: Prescriptions Over-the-Counter Drugs Herbals Vitamin / Mineral / Dietary / Nutritional Supplements
Generic Fall Risk Assessment Tool Visual Analog Pain Scale / McGill Pain Questionnaire AUDIT Test EASI Screen Complete the Assessment Tool Print Patient Name, Facility Code at Top Print, Sign Your Name, and Date at Bottom Place in Patient s Manila Folder in Clinic
A reporting period is annual Report on each new Medicare B / Replacement Plan patient in Carrier Sites All Agency Sites become Carrier Sites and REQUIRE PQRS reporting for ALL Medicare Replacement Plans Report according to CPT codes associated with each PQRS Measure Number
#126 Diabetes Mellitus Foot and Ankle Care Neuro Exam 97001 PT Eval / Re-Eval #127 Diabetes Mellitus Ulcer Prevention Footwear Evaluation 97001 PT Eval / Re-Eval #154 Falls - Risk Assessment and #155 Falls - POC 97001 / 97002 PT Eval / Re-Eval 97003 / 97004 OT Eval / Re-Eval #182 Functional Outcome Assessment 97001 / 97002 PT Eval / Re-Eval 97003 / 97004 OT Eval / Re-Eval #130 Documentation of Current Medications in the Medical record 97001 / 97002 PT Eval / Re-Eval 97003 / 97004 OT Eval / Re-Eval 92507 SLP Tx; 92526 SLP Swallowing Tx / 97532 Cog Skills Dev
#131 Pain Assessment and Follow-Up 97001 / 97002 PT Eval / Re-Eval 97003 / 97004 OT Eval / Re-Eval 92507 SLP Tx; 92526 SLP Swallowing Tx / 97532 Cog Skills Dev #128 Body Mass Index (BMI) Screening & Follow-Up 97001 PT Eval 97003 OT Eval #431 Unhealthy Alcohol Screening and Follow Up 97003 / 97004 OT Eval / Re-Eval #134 Screening for Clinical Depression & Follow Up Plan 97003 OT Eval #226 Tobacco Use: Screening and Cessation Intervention 97003, 97004 OT eval / re-eval 92521, 92522, 92523, 92524 Speech Evals #181 Elder Maltreatment Screen and Follow Up 97003 OT Eval