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Therapy PQRS Claims Measures

February 3, 2014 2 Comments

Therapy PQRS claims measures for physical and occupational therapy have changed in 2014.  Now is the time for therapy clinics that have never reported to take the dip into the PQRS pool, if nothing else to stave off the 2% penalty reduction in 2016 for non-participation, or optimistically to gain a 0.5% bonus for accurately reporting in 2014.  There are some hitches, so this post will provide you the handy references you will need to either get started with PQRS in 2014.  This post will address claims based reporting for PQRS.  (If you have a spare 60 minutes – you can listen to the webinar with Clinicient that was live on January 27th.)

If your private practice participated in the PQRS quality reporting system in previous years, you will want to ensure that the measures that you choose to report in 2014 are eligible measures.  Physical and occupational therapists can report on measures via claims (Free!) or via an approved registry ($$).

Therapy PQRS Claims Measures Listing

The Table below indicates the allowable claims based measure for physical therapists in 2014.  The descriptions for the measure can be found at the CMS PQRS website, but you will need a few hours of free time, and a lot of patience to get through everything, all the while crossing your fingers that you understand exactly what you are supposed to do if you are late to the game.  A better way, if you are an APTA member is to avail yourself the resources at the APTA PQRS website, some of which are available to members and non-members alike (including the measure themselves).  The AMA used to have all the measures, tabulation sheets and specifications available at their website for free, but they have only sampled a small percentage this year, and have made the remainder (translation – all the therapy measures are not free) in a eBook that can be purchased.

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
Select from these codes for claims based reporting. Note that there are 2 additional codes pertaining to wound care only applicable wherein wound care is provided, for sake of simplicity they are not included in this table.

Therapy PQRS Claims Measures: Getting Started

Welcome back (assuming you visited the CMS PQRS site as well as the APTA PQRS resources, and you know what to do at the very least to stave off the 2% payment reduction in 2016.  Review the measures (hopefully you got them from the APTA) and select 3 to report on (minimum to not have payment penalty in 2016).  Pay close attention to the amount of work that is required for data collection and claim reporting, and then determine which measure you will report on for at least 50% of the eligible beneficiary visits.  A word of caution, in case you missed it:  the medication measure (#130) requires reporting on more codes that the other measures, including therapeutic exercise (97110) and manual therapy (97140).  This is different from the other measure which most of the are triggered by evaluation or re-evaluation.  There are other measure specifications, but it the additional reporting requirements for this measure are worth of mention.

If you are ambition, select 6 measures (9 are required for the bonus, but there are only 6 available, so you will only report on six (note this does not include wound care).  This will be validated prior to your bonus payment.

Keep in mind that you may want to report through a registry, and at least one therapy EMR has a CMS approved registry, and there are other approved registries that you can also select.  In a registry the codes and reporting are somewhat different, and as mentioned likely a charge.

Are you looking to stave off the 2% penalty in 2016?  Which measure are you selecting for claims based reporting?  Is PQRS reporting having a positive impact on patient care at your practice?  Have you started yet?

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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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Comments (2)

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  1. kristin francis says:

    Hi Nancy,

    According to the AOTA website, OTs need to report on 9 measures to avoid a penalty. Is this this your understanding as well? If so, it seems like quite a time-consuming process!

  2. Hi Kristin. Thanks for your comments. The minimum 2014 PQRS measures for receiving the bonus that must be reported are 9. In some instance, such as physical therapy there are likely only 6 measures that can be reported (excluding wound care). The post addressed only the 6 “likely” measures that physical therapy would report to receive the 0.5% bonus. Both PT and OT would only need to report 3 measures to stave off the 2% payment penalty in 2016. There are actually more applicable measures for OT that there are for PT, and I will follow up with a post to clarify that.

    And yes, I do concur, that is a lot of work for reporting, particularly if you are not using a therapy EMR that is providing a level of automation to reporting. Keep in mind that the Medication measure requires reporting for 97110, 97140 and 97532 – so for many therapists that means reporting on this measure nearly every visit.

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