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2015 PQRS Physical Therapy Measures

February 27, 2015 10 Comments

Are you ready for the 2015 PQRS Physical Therapy Measures?  4400683944_a06fc5998a_bCMS is now requiring reporting on 9 measures across 3 quality domains including 1 cross-cutting measure. Perhaps you received a letter from CMS late last year indicating that your 2015 reimbursement in your private practice would be reduced by 1.2% because you did not participate in the 2013 CMS PQRS program.  If you did not participate in the CMS 2014 PQRS program your reimbursement in 2016 will be reduced by 2%.  On top of multiple procedure payment reductions (MPPR), as well as the sequestration reduction that is still in place, practices may be hard pressed to sustain continued downward reimbursement.

Get Started on the 2015 PQRS Physical Therapy Measures

CMS requires reporting on nine measures in 2015.  Physical therapists reporting via claims must report on all 6 measures (noted in the table below) in the 2015 year in order to meet the successful reporting requirements on at least 50% of qualified patients.  The quickest way to get started on PQRS is via claims- based reporting.  Physical therapists may also report via registry, however there are only a few CMS qualified PQRS registries specific to physical therapy and those are tied to EMR programs, or alternatively to FOTO.

If you successfully participated in PQRS physical therapy reporting in 2014 there are a few updates of note.  The Medication Measure no longer requires reporting on every visit were 97110 or 97140 was performed.  What may come as a surprise is that the BMI Measure requires that you actually weigh and measure the height of the patient in performance of the BMI calculation.  A patient self-report is not acceptable per the measure specifications.  I recently completed a complimentary webinar with Clinicient on 2015 PQRS reporting which is now available on demand for replay.  All the measures for PT, OT and SLP for claims reporting are reviewed.

Measure #Measure Description
128Preventive Care and Screening: BMI Screening and Follow-up
130Documentation and Verification of Current Medications in the Medical Record
131Pain Assessment Prior to Initiation of Patient Treatment
154Falls: Risk Assessment
155Falls: Plan of Care
182Functional Outcome Assessment
Table Note: Select all six 2015 codes for PT claims based reporting. Be sure to read 2015 measure specifications for each code to ensure compliance in reporting.

 

If you are participating with one of the therapy EMRs that has a CMS qualified registry, you should also check to see the cost of using the registry to satisfy 2015 PQRS reporting requirements for physical therapy.

Photo:  John Flinchbaugh via Compfight

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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  1. 2015 PQRS Physical Therapy Measures | HealthBACON | February 27, 2015
  1. Kevin Bridges says:

    Nancy,
    Thanks for this article. I’m a little confused and hope you could clarify something. Your article opens stating that CMS now requires reporting on 9 measures… But the rest of the article discusses reporting on only 6… Could you please clarify this?

  2. Hi Kevin – thanks for your question. CMS does require reporting on 9 measure in 2015 for claims reporting. However, there are only 6 available measures for physical therapists for claims reporting, so reporting on all measures is required. Have you started reporting yet?

  3. Nikita says:

    Hi Nancy,
    I had a query about these PQRS reporting. I am a part of a PT facility and we use claims for reporting to Medicare currently. On certain PQRS measures particularly Pain (#131) and Functional Outcome Measures (#182), the frequency requires them to be reported ‘every visit”. Since we see patients atleast 3-4 times/week, are we supposed to submit these measures everyday? And if yes, which CPT code do we submit them with, as we usually use 97110, 97112, 97140 codes for billing everyday and none of these are in the denominator codes for these 2 PQRS measures. Can you possibly help me understand it better? Thanks!

  4. Hi Nikita, thank you for your question. The PQRS Measures for 2015 have been updated, as well as the requirement for successful reporting on each measure. You should ensure that your are using the most up-to-date information for 2015 – which can be found at the CMS PQRS webpage. For APTA members, there are hand reference sheets for each PQRS Measure that outline the triggering event (by CPT code), as well as the successful reporting requirements. Last year several codes, including Medication Management, required reporting for visits beyond the initial evaluation to include therapeutic exercise (97110) and manual therapy (97140). That is no longer the case this year, so it is important to have the most up to date measure specifications. Please let me know if you have additional questions.

  5. Mon Caddauan says:

    Hi Nancy,
    Kindly make a brief recap on the PQRS reporting for PT in 2016 including frequency of reporting
    Thank you

  6. Hello Mon, and thank you for your comment. PQRS 2016 updates coming shortly.

  7. Stacey says:

    Hi Nancy,

    I’ve enjoyed reading your informative posts. We are a small outpatient orthopedic PT clinic. We just learned that we haven’t been performing our claims-based reporting correctly for 2015 and the only way to fix to avoid penalty is to report all of 2015 through a registry. My question is regarding the two additional measures on diabetes which are required for registry based reporting. My understanding is that if a patient does not have a medical diagnosis of diabetes, then we simply do not report anything for this measure. However, if a patient has a medical diagnosis of diabetes and yet I am not treating him for this condition and therefore my ICD 9 or ICD 10 codes do not include a diabetes diagnosis code, am I required to report this measure for this patient?

  8. Hi Stacey, and thank you for your post and question. The two additional measures that are required for registry reporting related to diabetes. Here are the links to the measure specifications so that you can review the reporting requirements. Keep in mind that there are medical DX and therapy DX. Here are the links (posted at the APTA website): Measure 126 and Measure 127.

  9. Stacey says:

    Hi Nancy,

    Thanks so much for your response and Happy New Year! I have reviewed the links you provided. One follow up question – I have not reported any of the ICD9/10 diagnosis codes listed in the denominator section (the 250 codes – we don’t use those codes). Therefore, would that mean that I don’t need to report on this measure using the registry since there are no applicable patients, or should I be using these 250 codes?

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