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Therapy PQRS – Are You Reporting Correctly?

February 26, 2014 2 Comments

PQRS measures and reporting have changed for 2014, and if you are not aware of the changes, your reporting could cost you 2% of your 2016 payments from Medicare!  For physical therapists doing claims based reporting there are 8 eligible measures, and for occupational therapists there are 9 eligible measures.  Therapists must report at least 9 measures covering at least 3 NQS domains, OR, if less than 9 measures covering at least 3 NQS domains apply  then report 1-8 measures covering 1-3 NQS domains.  This represents a steep increase over last years’ reporting requirements.

Each measure must be reported for at least 50 percent of the Medicare Part B FFS patients seen during the reporting period to which the measure applies.  So there you have it – the PQRS system requires that you report on 9 measures in order to received the o.5% bonus payment, however if not all available measure are applicable, the claims will go through the Measure Applicability Validation Process (MAV) which will allow QualityNet to determine whether you should have reported quality data codes for additional measures and/or covering additional NQS domains.

Therapy PQRS – Are You Reporting Correctly?

There is a hidden danger in relying on anecdotal evidence, (or your experience from last year) when reporting PQRs on your claims.  An area to highlight as the perfect example is Measure #130 – Medication Management.

  • Do you know which CPT codes require reporting of the Medication Management measure?
  • Do you know what is required for you to properly report your compliance with this measure?

Let’s take a look at the Measure Description:

Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter.  This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration.

There is a bit more work in collecting information on this measure than just adding the medications list to the chart that your patient provided.  Don’t you think?  If you are going to be compliant with the measure (and there is no way out of using this measure if you are going for the 0.5% bonus) you might have to develop a formatted medication list for your patient to fill out to contain all the required information as noted above.

But wait – there’s more…

This might be the kicker for you:  Medicare Management Measure #130 therapy PQRS reporting is required on the following CPT codes that used by PTs and OTs on almost a daily basis!

  • 97001/97002
  • 97003/97004
  • 97110
  • 97140
  • 97532

You might be a bit surprised, as last year reporting was only required on the eval/reeval codes and 97532.  This year if you report as you did last year, leaving out 97110 and 97140 your compliance with reporting will not be accurate, and if you rely on this for the bonus, or worse if you are relying on this measure as one of the 3 needed to stave off the 2% payment reduction in 2016, you will be out of luck.  Your claims will still process correctly, because validation of PQRS compliance is not done by the CMS MACs via the claims, but rather by the PQRS CMS contractor QualityNet.

Not to worry, you now have the information on therapy PQRS reporting for Medication Management Measure #130.

Do you know the rules for the rest of the measures that you are reporting?  Have you made a decision on whether to go for the bonus, or just to stave off the penalty?

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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. Very well done, Nancy. Feedback we are getting from our clients indicates there is still a lot of confusion about the Medication Measure. It is important to have a system in place to document a medication review at every visit to successfully comply with that measure. I don’t think it has to be a big task, but it has to be done correctly.

    Thanks again for your insight.


  2. Thanks Jerry – there is a lot of misinformation, and this post is in response to an inquiry yesterday from an OT insisting that they had to report 9 measure to avoid a penalty. The information at is a lot to dig through, and the measure book (tucked in a zip file) is over 600+ pages. The AMA provided “free” resources last year (excellent for beginners in my opinion), but this year the AMA resources are only available in an eBook that has to be purchased. FYI I purchased the book.

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