Physidan Quality Reportin System

Transcription

1 PQR Physidan Quality Reportin System Presented to the AKA Getting started with PQRS Providers who participate between are eligible for incentive payments is they successfully transmit the information to ems If you are not successfully reporting by 2013 reporting period and beyond you will face a penalty oflowered Medicare reimbursement beginning in is the last volunteer year to report Remember: there is an additional penalty for not having Electronic Health Records by ' I I Q~' I ;, No registration is required to participate in PQRS To receive an incentive bonus for participating you must report on all measures applicable to DC's The only exception is if you do not have a certified PQRS qualified or other EHR system 3 Quality Measures Measure #124 Health Information Technology: Adoption/Use of Electronic Health Records Measure #131 Pain Assessment and Follow-Up Measure #182 Functional Outcome Assessment

2 Measure #131and #182 you will report on every visit for every Medicare patient that is older than 18and who is treated with a CMT arid reported 98940, or Measure #124 you only report this if you have adopted and are using a certified PQRS system or other acceptable EHR system. If you do have an acceptable system on every patient every visit. In 2012, at least 50% of your Medicare patients must be reported to qualify for bonus Measure #124 Purpose EHR to collect data on whether doctors are using Providers ask to report whether they are using a system certified by Authorized Testing and Certification Body or PQRS qualified Provider reports G-codes below on line 24 D of a paper claim or on service line 24 of an electronic claim, ~-',.f, Measure #124(cont) G-8447 Encounter documented using a ATCB Certified EHR system G-8448 Encounter documented using a PQRS Qualified system Purpose for CMS to collect data on when pain assessments are performed. Examples of pain assessments: Briefpain inventory(bpi), Faces pain scale(fps), McGill Pain Questionaire (MPQ), Multi-dimentional Pain Inventory(MPI), Neuropathic Pain Scale(NPS), Numeric Rating Scale, Oswestry Disability Index(ODI), Roland-Morris (VNRS), and visual Analog Scale (VAS)

3 Measure #131 (cont.) Providers are ask to report whether they provided a pain assessment to the patient and documented a follow-up plan related to that assessment. Follow-up plan must include a planned time to reassess the patient for pain and may also include documentation of future appts, education, referrals, of notification of other care providers Report the G-code below on line 24 D of a paper claim or line 24 of an electronic claim There may be times when it is not appropriate assess for pain prior to initiation of care There are 5 G codes to choose from for this rneasuresm to G8730 Pain Assessment Documented as Positive and Follow-Up plan documented (pain was present and follow-up plan that stated a specifically stated a planned reassessment of pain i.e. future appts, education, referrals, notification of other care providers G8731Pain Assessment Documented as Negative, No Follow-Up plan Required G8442 Patient not Eligible for Pain Assessment for documented reasons The provider documented that patient was not eligible for a pain assessment. They are not eligible for the following reasons: - patient refuses to participate -severe mental or physical incapacity where patient cannot express self where others can understand -patient is in an urgent or emergent situation where time is of the essence and to delay would jeopardize the patient's health

4 G-8732 Pain Assessment not documented, Reason not specified The provider did not assess the patient for pain and there is no documented reason not performed G-8509 Pain Assessment Documented as Positive, Follow-Up Plan not documented, reason not specified The provider assessed the patient for pain, pain was present but did not document a follow-up plan and did not document a valid reason why no follow-up plan --~-,.~----: ~asure#182 -~--~~ j; tln<ptj~radnqutoomeha&&es5.elile nt functional assessments are performed. Documentation must include the name of the standardized tool used Tools that assess pain alone such as a visual analog scale does not meet the criteria Providers are asked to report whether they conducted a functional outcome assessment and if they documented a care plan Care plan would include goals based on deficiencies found in the assessment, future appointments, future procedures, and other information that would describe next steps for treating patient's condition Provider should report one of the 5 applicable G- eodes on line 240 on a paper claim or on service line 24 on electronic claim The assessment tool should be performed at a minimum of every 30 days but reporting is required on each visit. For visits occurring within 30 days of previously documented assessment, G-8540 should be used (current functional outcome assessment not documented, patient not eligible) G-8539 Current Functional Assessment and Care Plan Documented A functional assessment was performed and provider documented a care plan, including goals based on deficiencies found

5 G-8542 Current Functional Outcome Assessment documented, no functional deficiencies, care plan not required Measure #182 continued G-8540 Current Functional Assessment not documented, patient not eligible A functional assessment was not performed and the provider documented a reason why. A patient not eligible for the following reasons: Patient refuses to participate Patient is unable to answer the questionnaire The provider has a current functional assessment on file that was completed within 30 days Measure #182 G-8541 Current Functional Assessment documented, Reason not specified not Measure #182 G-8543 Current Functional Outcome Assessment Documented, Care Plan not documented, reason not specified