Revised 4/7/2016

PQRS for 2016

WHAT IS PQRS?

PQRS is the Physician Quality Reporting System.

It is calculated per NPI and per Tax ID combination.

Only applies for Medicare Part B (primary and secondary) and Railroad patients (not Medicare advantage plans or Medicare DMERC)

Sammy reporting is done via registry only in 2016.

o Registry reporting happens at the end of the year with a single report that is submitted through our registry, and there is a fee.

HOW TO AVOID THE PENALTY

You must report on 50% of eligible patients (patients that trigger a PQRS event) on 9 measures. With the automatic method you will surpass that because SammyEHR records

100% of the time. The penalty if not successfully reported is 2% in 2018. If you utilize our workflows your reporting will be 100%. However if you do NOT PERFORM WELL in

relation to your cohort you can receive up to an additional 2% reduction in fees. Moral of the story report and meet the measures as often as possible. You MUST perform each

measure at least once for it to count in the reporting numbers.

Your performance is being compared to the performance of other providers to determine what your penalty will be.

If you have SammyEHR we offer automatic PQRS reporting for podiatrists only.

We have selected 14 measures to choose from, you only have to perform 9 however when you bill an eligible visit Sammy will record it anyway and at the end of the reporting

period we will take the 9 measures you want to report on, so as long as you performed each measure at least one time.

Side note: If you do not do MU in 2016 you get an additional penalty in 2018

CONCEPTS TO UNDERSTAND

Each measure has CPT II codes associated with them (some are referred to as G codes or F codes).

Some CPT II codes mean that you have done something (performance met) and some CPT II codes mean that you haven’t done something (performance not met), and

some mean that you have an exclusion. Exclusions do not count for or against you.

We recommend that as often as possible you report positively.

If you simply report a CPT II code you are reporting and it counts towards your 50% (reporting requirement) (whether meeting the measure or not).

What is an Eligible patient?

o An eligible patient means that the patient meets the criteria required to be reported on for a certain measure it is known as a PQRS event.

o Each measure has its own age range, frequency (per visit, or once per reporting period), diagnosis and procedure codes that will make a patient eligible.

Example: Measure 163 age range is 18-75 years or older and within the last 12 months Diagnosis:

|250.00|250.01|250.02|250.03|250.10|250.11|250.12|250.13|250.20|250.21|250.22|250.23|250.30|250.31|250.32|250.33|250.40|250.41|250.42|250.43|250.50|250.51|

250.52|250.53|250.60|250.61|250.62|250.63|250.70|250.71|250.72|250.73|250.80|250.81|250.82|250.83|250.90|250.91|250.92|250.93|357.2|362.01|362.02|362.03|36

2.04|362.05|362.06|362.07|366.41|648.00|648.01|648.02|648.03|648.04|

Procedure Codes:

|99201|99202|99203|99204|99205|99211|99212|99213|99214|99215|99217|99218|99219|99220|99221|99222|99223|99231|99232|99233|99238|99239|99281|99282

|99283|99284|99285|99291|99304|99305|99306|99307|99308|99309|99310|99315|99316|99318|99324|99325|99326|99327|99328|99334|99335|99336|99337|99341

|99342|99343|99344|99345|99347|99348|99349|99350|99455|99456|G0402|G0438|G0439|

Revised 4/7/2016

Automatic PQRS for Podiatrists

Sammy’s automatic PQRS allows the provider to report on all measures. We encourage you to utilize the work flows listed below in Sammy and SamNotes in order

to report positively most of the time. But remember you need to perform the measure at least once.

After you do a claim in SammyEHR the automatic PQRS screen will pop up and let you know what performance codes you are reporting for each measure. For

some measures you will find that you won’t report for a specific patient. Please look at the measure sheets to look at age, diagnosis and the procedure for that

measure to figure out why Sammy didn’t report that measure. Some measures will report that the measure was MET and others will state that it was NOT met.

You want to do your best to MEET each measure as many times as possible. This year you can also report on measure 126 and 127. These two measures can only

be reported via registry. We encourage you to report these measures because they are specifically for podiatry as is measure 163..

Measure

Sheets from

CMS

Performance

MET

This area being blue

means that the

patient is not in the

denominator and it

will not count against

you

How many times you

MET the measure,

should be at least 1

time for each measure

Performance

NOT MET

Right click on the numerator for more patient details

Revised 4/7/2016

Claim History

After the PQRS screen pops up you can see the results in the claim history. If you double click where it says PQRS= you will see all the measures and the

performance codes. If you double click on any line you will open up the measuresheet.

Revised 4/7/2016

Measure Performance Codes How Often? Age Range Who has to do it? The Sammy Way

47 Advanced Directives Patient Process

1123F-8P: Advance Care Planning not Documented, Reason not Otherwise Specified

Once per reporting period

Patients that are 65 years and older

Doctor or User This code will record if you don’t check ANY boxes. Bill the proper E&M code on patients that are 65 years or older.

1123F: Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record

To record this code click on the make changes button and click on the More Patient area in SammyEHR. Click on the Advanced directives tab then click on the checkbox below. Bill the proper E&M code on patients that are 65 years or older.

1124F: Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan

To record this code click on the make changes button and click on the More Patient area in SammyEHR. Click on the Advanced directives Tab and click on any choice other than the surrogate choice. If the exam was done before click on the Reviewed button to receive credit. Bill the proper E&M code on patients that are 65 years or older.

Revised 4/7/2016

Measure Performance Codes How Often Age Range Who has to do it The Sammy Way

109 Osteoarthritis Function and Pain Assessment For you to report on this measure you must bill a 715.XX Diagnosis Visit

1006F: Osteoarthritis symptoms and functional status assessed

Each Visit Patient aged 21 years and older

Staff or Doctor Sign in as the doctor or a user and document the pain scale while using the chief complaint template, RFC or the Pain structure <Pain||Pain> in SamNotes and bill a 715. XX diagnosis. Both the Existing complaint date and the date of service must be the same in order to meet this measure in SammyEHR.

1006F-8P: Osteoarthritis Symptoms and Functional Status not Assessed, Reason not Otherwise Specified

Don’t document the pain scale in SamNotes and bill a 715.XX diagnosis.

Revised 4/7/2016

Measure Performance Codes How Often Age Range Who has to do it The Sammy Way 110 Flu Vaccine Patient Periodic

G8482 Influenza immunization administered or previously received

This measure is to be reported a minimum of once for visits for patients seen between January and March for the 2015-2016 season and a minimum of once for visits for patients seen between October and December for the 2016-2017 season.

6 months and older

Staff or Doctor Open up the ARRA one screen and document that the patient received the flu shot for the season.

G8483: Influenza immunization was not administered for reasons documented by clinician.

PERFORMANCE EXCLUSION Open up the ARRA one screen and document the Medical/Personal Reason for declining immunization, document reasons for not administering.

G8484 Influenza immunization was not administered, reason not given

Open up the ARRA one screen and document Not immunized

Measure Performance Codes How Often? Age Range Who has to do it? The Sammy Way 111 Pneumonia Patient Process

4040F Pneumococcal vaccine administered or previously received

Once within the reporting period. They could have gotten this vaccination years ago it will still count.

65 years and older Staff or Doctor Open up the ARRA one screen and click on Yes under the Pneumococcal Vaccination.

4040F-8P Pneumococcal vaccine was not administered or previously received, reason not otherwise

Click No or do nothing on the ARRA one Screen (not recommended)

Revised 4/7/2016

Measure Performance Codes How Often? Age Range Who has to do it? The Sammy Way

126 Diabetic Foot and Ankle care

G8404: Lower extremity neurological exam performed and documented

A minimum of once per reporting period, however the exams must be done at least once within 12 months of the DOS

18 years and older with a diagnosis of diabetes.

Doctor must be signed in

Sign in as the doctor and document the 5.07 filament (Semmes) and one of the following: reflexes, vibratory, proprioception, sharp/dull and utilize the PQRS + screen to document the Risk Categorization. Bill diabetes and the correct procedure code.

G8405: Lower extremity neurological exam not performed

Don’t do it. Bill diabetes and the correct procedure code.

The text in the bottom of the PQRS + screen is able to be copied and can be pasted into the note, but this text CAN go automatically into notes if utilizing the chief complaint macro or RFC Macro. Shipped for Medicare patients only, in the Podiatry settings in SamNotes there is a checkbox to enable this feature for all patients. In the chief complaint and RFC, the text would NOT be used unless there is text in both the vascular and neuro exams.

Revised 4/7/2016

Measure Performance Codes How Often? Age Range Who has to do it?

The Sammy Way

127 Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of footwear

G8410: Footwear evaluation performed and documented

A minimum of once per reporting period, however the exams must be done at least once within 12 months.

18 years and older with a diagnosis of diabetes.

Doctor must be signed in

The doctor needs to sign into SammyEHR and document something in each of the following exams in SamNotes: Vascular, Neuro, Derm, Ortho buttons AND document the Risk Categorization in the PQRS + button. For those clients who do not use our workflows it is important to put the shoe size and how the size of the foot was measured. Bill diabetes and the appropriate procedure code.

G8415 Footwear evaluation was not performed

Don’t do the above. Bill diabetes and the appropriate procedure code for patients that are over 18.

The text in the bottom of the PQRS + screen is able to be copied and can be pasted into the note, but this text CAN go automatically into notes if utilizing the chief complaint macro or RFC macro. Shipped for Medicare patients only, in the Podiatry settings in SamNotes there is a checkbox to enable this feature for all patients. In the chief complaint and RFC, the text would NOT be used unless there is text in both the vascular and neuro exams.

Revised 4/7/2016

Measure Performance Codes How Often? Age Range Who can do It? The Sammy Way

128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

G8420 BMI is documented within normal parameters and no follow-up plan is required

The BMI must be documented within the last 6 months

Patients aged 18 years and older

Staff or Doctor Sign in to the system and document the height and weight via exam and bill the appropriate procedure code. If the BMI Is out of range a follow up plan must be documented.

G8417: BMI is documented above normal parameters and a follow-up plan is documented

G8418: BMI is documented below normal parameters and a follow-up plan is documented

G8422: BMI not documented, documentation the patient is not eligible for BMI calculation

G8938: BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible

G8421: BMI not documented and no reason is given

G8419: BMI documented outside normal parameters, no follow-up plan documented, no reason given

Must click on

EXAM for

PQRS

Revised 4/7/2016

Measure Performance Codes How Often Age Range

Who can do it The Sammy Way

130 Documentation of Current Medications in the Medical Record

G8427 Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications

Each visit must be documented on the DOS that the patient is seen.

18 years or older

Doctor MUST sign in as the doctor and click on I have reviewed this patient’s medications today.

G8430 Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional

G8428 Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given

Revised 4/7/2016

Measures 154 and 155 are two measures that go together. You can only report on 155 if you are reporting that there is an injury or falls for measure 154. The falls button will

turn different colors depending on what is done on the ARRA one screen as well as if the assessment was completed.

Measure 154 consists of a screening and then the assessment. We recommend that you print out the screening and give it to the patient if they have falls.

On the ARRA One screen when the Yes is clicked the Falls button will turn orange. The orange color is alerting you to the fact that you must choose if the patient has one fall with

an injury or two or more falls (screening). Make the choice and click on Continue to move on to the Assessment.

The falls button will turn red if the assessment was not completed. To complete the assessment click on Continue and fill out the Home Safety Questionnaire and the Follow-Up

Assessment and Findings (for Measure 155 you must also do the Planning tab). On the last screen (Planning) you have the option to Save and Print the Report (save to the filing

cabinet or Save and Close (just saves to the button).

Option to

Select All or

None

Follow Up

Assessment

and Findings

Measure 154 Planning Tab

Measure 155

Home Safety

Questionnaire

(Assessment)

Measure 154

Revised 4/7/2016

Measure Performance Code How Often Age Range

Who can do it The Sammy Way

154 Falls Risk Assessment Reporting codes 3288F and 1100F are reported together to account for both the screening and the assessment.

3288F: Falls Risk Assessment documented

12 months 65 years or older

Staff can do the ARRA one screen selection but only the doctor can do the assessment and plan

Choose one of the two bottom choices on the falls screening then complete the falls risk assessment.

Bill a patient who is 65 or older and bill the appropriate E&M code.

1100F: Patient Screened for future fall risk: documentation of two or more falls in the past year or any fall with injury in the past year.

Document either No or Yes on the ARRA one screen or any of the choices in the Falls Screening questions. Bill a patient who is 65 or older and bill the appropriate E&M code.

Revised 4/7/2016

3288F-1P: Documentation of medical reason(s) for not completing a risk assessment for falls.

Select Will Not/Cannot Report then choose a reason. Bill a patient who is 65 or older and bill the appropriate E&M code.

1101F: Patient screened for future fall risk: documentation of no falls in the past year or only one fall without injury in the past year

Select NO falls or One fall without an injury. Bill a patient who is 65 or older and bill the appropriate E&M code.

1101F-8P: No documentation of falls status patient isn’t eligible

Do absolutely nothing. Bill a patient who is 65 or older and bill the appropriate E&M code.

3288F-8P: Falls risk assessment NOT completed, reason not otherwise specified.

Document falls in the ARRA one screen or any selection in the Falls screening but do NOT do the assessment

Revised 4/7/2016

Measure Reporting Codes How Often

Age Range Who can do it The Sammy Way

155 Falls: Plan of Care

0518F: Plan of care documented

Same as measure 154

Same as measure 154

Same as measure 154

Document the plan of care in the falls button in SamNotes and bill the appropriate E&M code.

0518F-8P: Plan of care NOT documented for the patient with 2 or more falls or injurious falls.

DO NOT document the plan of care.

Revised 4/7/2016

Measure Performance Codes How Often Age Range Who can do it The Sammy Way

226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

4004F: Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user

Sammy is looking for the screening to be done within 24 months as well as smoking counseling if a smoker.

18 years and older

Staff or Doctor Sign in as a doctor or staff member and document smoking status along with the cessation.

1036F: Current tobacco non-user

Sign in as a doctor or staff member and document smoking status of non tobacco user.

4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reasons)

This is a performance exclusion

4004F with 8P: Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified

Do not do anything.

Revised 4/7/2016

Measure Performance Codes How Often Age Range Who can do it The Sammy Way

317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

G8783: Normal blood

pressure reading

documented, follow-up not

required

Once per reporting period BUT must do the blood pressure screening on Same DOS.

18 years and older

Staff or Doctor Sign into Sammy and click on the ARRA one Screen and document the vitals signs for the DOS. If you need to correct and backdate the vitals you can go into SamNotes. Please note that this must be by EXAM. If there is a pre-hypertensive blood pressure or hypertensive BP you will need to follow that up with follow up care.

G8950: Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented

G8784: Blood pressure reading not documented, documentation the patient is not eligible

G8951: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible

G8785: Blood pressure reading not documented, reason not given

G8952: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

Revised 4/7/2016

Measure Performance Codes The Sammy Way

358 Patient

Centered

Surgical Risk

Assessment and

Communication

This can be done by the doctor or the staff Set up: Step 1: To report on this measure you must first already know that a surgery will be performed. In the letter generator create/select a letter that start with the letters IC (informed consent). Step 2: Double click on the template and you will see a list of surgical codes click on one and the template will show up. Save/Print the Informed consent. Step 3: Complete the Surgical Risk Calculator (you can use the one we have or you can use your own). The Button is located in the Letter Generator Step 4: Save the Surgical Risk Calculator to your computer. Step 5: Click on the filing cabinet for that patient and click on Import New Document Step 6: Browse for the Surgical Risk Calculator that you saved to your computer make sure you put in the Type as Surgical Risk click on Move original (if you saved to your desktop), then click Add File. Step 7: Select the code again when it pops up (codes just used will default to the top) and click Continue. Step 8: Bill the procedure code for a Medicare patient.

G9316: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family.

Do the above.

G9317: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family NOT completed.

Don’t do the above.