February 17, 2015 PQRS 2015 Please note: ICANotes does not claim to have full and definitive information about PQRS in this document and cannot make definitive interpretation about PQRS questions. Information below refers to CMS documentation and links. Please refer to these links for full interpretation. A good reference is the QualityNet Help Desk available at 866-288-8912 or via email at: Qnetsupport@sdps.org PQRS has undergone some changes for 2015. The source for Information about PQRS is available at:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Spotlight.html What are the PQRS requirements for Calendar Year 2015? Reporting requirements include the need to report on 9 measures (if 9 are available) from 3 different “domains” and 1 cross-cutting measure. Domains and Cross-cutting Measures are listed later in this document. Who is eligible to report on PQRS? A list of eligible professionals can be found at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf Where can I get help with PQRS : The QualityNet Help Desk is available at 866-288-8912 Monday – Friday; 7:00 AM–7:00 PM CST or contact the Help Desk via Email: Qnetsupport@sdps.org

Do I need to register to participate in PQRS? No registration is needed to participate in PQRS.

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What are the ways Individual EPs can report on PQRS in 2015?

According to CMS, to participate in the 2015 PQRS, individual EPs may choose to report information on individual PQRS quality measures

or measures groups using the following methods:

(1) Medicare Part B- Claims Based Reporting (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/PQRS/Downloads/2015PQRS_Claims_CodingRpgPrinc.pdf Only report individual measures via Medicare Part B

claims. No group measures can be reported via claims.

Also see: Claims based reporting Made Simple: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/PQRS/Downloads/2015PQRS_Claims_Made_Simple.pdf

(2) QCDR (Qualified Clinical Data Registry) Reporting: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/PQRS/Qualified-Clinical-Data-Registry-Reporting.html

(3) Qualified Electronic Health Record (EHR) product http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/PQRS/Electronic-Health-Record-Reporting.html (ICANotes is not able to submit PQRS data electronically.)

(4) Group Practice Reporting Option (GPRO) http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/PQRS/Group_Practice_Reporting_Option.html

Medicare Part B Claims Reporting ICANotes customers may find reporting via Medicare Part B Claims the most effective method at this

time. A sample completed 1500 claim form completed for PQRS can be found at the end of this document.

Here is a document that explains Claims Reporting: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015PQRS_Claims_Made_Simple.pdf

How often to I report on a particular measure? Reporting frequency is specific to each measure.

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What is the penalty for not reporting PQRS? Providers who do not report in 2015 will be subject to a 2 % payment adjustment in 2017. There is no longer an incentive payment for PQRS reporting as of 2015.

What are the 2015 requirements for avoiding the penalty? Professionals who wish to meet the PQRS requirement for 2015 to avoid the payment adjustment must report on 9 individual measures from 3 different domains and 1 cross-cutting measure (new for 2015) if they have at least 1 Medicare patient with a face-to-face encounter.

What if there are less than 9 relevant measures? In behavioral health there are less than 9 relevant measures available for claims-based reporting in 2015.

• If less than 9 measures apply to the eligible professional, then the EP must report 1-8 measures over 3 National Quality Strategy (NQS) domains including 1 cross-cutting measure AND report each measure for at least 50% of the eligible professional’s Medicare Part B FFS patients seen during the reporting period to which the measure applies. The eligible professional would then be subject to Measure-Applicability Validation (MAV).

If reporting less than nine measures across at least three National Quality Strategy (NQS) domains the following applies to the eligible professional:

Report one to eight measures covering one to three NQS domains and Measures with a zero percent (0%) performance rate would not be counted.

Report each measure for at least 50% of the Medicare Part B Fee-for-Service (FFS) patients seen during the reporting period to which the measure applies.

Report on at least one Cross-Cutting measure in the one to eight measures. See below for which measures are Cross-Cutting Measures.

What is the Measure-Applicability Validation process? This is a process by which Medicare determines whether there were other measures that a provider should have reported on. Information can be found at: 2015 PQRS Measure-Applicability Validation (MAV) Process for Claims Based Reporting: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html

Where is the Penalty/Payment Adjustment information?- See http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html

PQRS National Quality Strategy (NQS) Domains for 2015:

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• Patient Safety • Person and Caregiver-Centered Experience and Outcomes • Communication and Care Coordination • Effective Clinical Care • Community/Population Health • Efficiency and Cost Reduction (Each measure is assigned one of these domains.)

What is the minimum reporting I have to do to avoid the payment adjustment? There is no minimum if you don’t qualify for enough measures; however one of those that you report on should be a Cross-Cutting Measure. On the list below, the behavioral health related measures are indicated whether or not they are Cross-Cutting Measures.

If you don’t qualify for 9 measures you report on all those relevant to your practice. If it is less than 9 you will be subject to the Measure-Applicability Validation (MAV) process which according to CMS is defined as “a measure- applicability validation (MAV) to determine whether they [providers] should have submitted additional measures or additional measures with additional domains to be considered incentive eligible.”

How do I do PQRS Claims-based reporting through ICANotes? To do claims-based reporting, measures are reported on your HCFA form 1500 as Category II CPT codes and/or G-Codes (QDC’s - Quality Data Codes) that describe the clinical action required. Codes are indicated on the pages that follow.

Where is the PQRS Button in ICANotes?

A PQRS button is in PN Part 2, Finish Initial and the Edit Work Area screens which allows the selection of PQRS codes that apply to the

session. PQRS codes will be included on the HCFA, although there is a limit of 6 codes (including all service codes) that can be put on the

HCFA.

These are billed as $0.01. Each claim form should only address the measures related to that patient visit. A charge of $0.01 should be put in

the charge line-item to indicate that these are PQRS measures.

What happens after I submit a claim with PQRS measure(s) included? After submitting a claim with PQRS code(s) added, you will receive a notification with either the CO 246 N620 or the N620 denial code which is an indication that the PQRS codes have been received into the National Claims Registry. You will get a notice with one of these codes each time you submit a claim form with a PQRS code(s). This indicates that a PQRS related claim has been received. It is not the final word on whether or not you qualify for the incentive. You may wish to keep track for your records of all of the PQRS claims you have submitted.

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What are the individual measures and their domains that may be relevant for Behavioral Health Professionals in 2014?

(A full list of ALL measures including those not eligible for claims-based reporting can be found in this file: http://www.cms.gov/apps/ama/license.asp?file=/PQRS/downloads/2015_PQRS_IndividualMeasureSpecs_SupportingDocs_111214.zip)

Note: Several previous PQRS eligible behavioral health measures are no longer available for claims-based reporting.

PQRS 2015 Behavioral Health Claims-Based Measures

The measures listed below are most relevant to behavioral health and available for submission via claims-based reporting.

Medication Reconciliation (Measure # 46) Cross-Cutting Measure Domain: Communication & Care Coordination

Care Plan (Measure # 47) Cross-Cutting Measure Domain: Communication and Care Coordination

Preventive Care and Screening: BMI Screening and Follow Up (Measure # 128) Cross-Cutting Measure Domain: Community/Population Health

Documentation of Current Medications in the Medical Record (Measure # 130) Cross-Cutting Measure Domain: Patient Safety

Pain Assessment and Follow-Up (Measure # 131) Cross-Cutting Measure Domain: Community/Population Health

Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan (Measure # 134) Domain: Community/Population Health

Elder Maltreatment Screen and Follow-Up Plan (Measure # 181) Domain: Patient Safety

Preventive Care and Screening: Tobacco use assessment and tobacco cessation intervention (Measure # 226) Domain: Community/Population Health

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PQRS Individual Measures 2015

PQRS Measure Domain Denominator What Needs to Be

Determined Numerator When to Report G code/CPTII-

that would be added or pulled from ICANotes to 1500 claim form

*Measure #46 (NQF 0097) Medication Reconciliation *Cross-Cutting Measure

Patient Safety All patients 65 years and older discharged from any inpatient facility and seen within 30 days following discharge in the office by the professional.

Percentage of patients aged 18 years and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care who had a reconciliation

Patients who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented

Reported at an outpatient visit occurring within 30 days of each inpatient facility discharge date during the reporting period

1111F: Discharge medications reconciled with the current medication list in outpatient medical record OR If patient is not eligible for this measure because patient was not discharged from an inpatient facility within the last 30 days, there are no reporting requirements in this

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

of the discharge medications with the current medication list in the outpatient medical record documented

case.

OR 1111F-8P Discharge medications not reconciled with the current medication list in outpatient medical record, reason not otherwise specified

*Measure # 47 (NQF 0326) Care Plan *Cross-Cutting Measure

Communication and Care Coordination

All patients aged 65 years and older.

Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an

Patients who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care

Once per reporting period for patients seen during the reporting period.

1123F –

Discussed and documented; advance care plan or surrogate decision maker documented in the medical

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

record.

OR1124F – Advance Care Planning discussed and documented in the record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.1124F -If patient’s cultural and/or spiritual beliefs preclude a discussion of advance care planning.OR Not documented, reason not otherwise specified.

1123F with 8P

Action not performed and reason not otherwise specified.

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

*Measure # 128 (NQF 0421) Preventive Care

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

*Cross-Cutting Measure

Community/ Population Health

All patients 18 +. Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter

Patients who have a documented BMI during the visit or the previous 6 months, AND when BMI is outside of normal parameters, follow-up is documented during the encounter or during the previous 6 months of the encounter with the BMI outside of normal parameters.

Once per reporting period for patients seen during the reporting period.

G8420 BMI documented within normal parameters and no follow-up plan required. OR G8417 BMI documented above normal AND follow-up documented OR G8418 BMI is documented below normal and a follow-up plan is documented. OR BMI Not documented, patient not eligible G8422 OR G8938 BMI documented outside of normal limits, follow-up plan not documented, documentation the patient is not eligible. G8421 BMI not

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form documented, no reason given OR G8419 BMI documented outside of normal, no follow-up plan documented, reason not given

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

*Measure # 130 (NQF 0419) Documentation of Current Medications in the Medical Record

*Cross-Cutting Measure

Patient Safety

All visits for patients aged 18+.

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

Professional attests to documenting, updating or reviewing a patient’s current medications including prescriptions, over-the counter, herbals and dietary supplements. Includes the dosages, frequencies and type

of administration.

Each visit during the 12 month reporting period.

G8427 Attests to documenting in the record that professional obtained, updated or reviewed the patient’s current medications. OR G8430 Attests to documenting in the record the patient is not eligible for a current list to be obtained, updated or reviewed OR G8428 –Current list of medications not documented, reason not given.

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

*Measure # 131 (NQF 0420) Pain Assessment and Follow-Up

*Cross-Cutting Measure Percentage

of visits for patients

aged 18 years and

older with

documentation of a

pain assessment

using a standardized

tool(s) on each visit

AND documentation

of a follow-up plan

when pain is present

Community/ Population Health

All visit for patients aged 18 years and older.

Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present.

Patient visits wit a documented pain assessment using a standardized tool(s) AND documentation of a follow-up plan when pain is present.

G8730 Patient assessment documented as positive AND Follow-up Plan Documented OR G8731 Pain Assessment Documented as Negative, No Follow-Up Plan required OR G8442 Pain Assessment not Documented Patient not Eligible OR G8939 Pain Assessment Documented as Positive, Follow-Up Plan not Documented, Patient not Eligible OR G8732 Pain Assessment not Documented, Reason not Given G8509 Pain Assessment Documented as

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form Positive, Follow-up Plan not Documented, reason not Given

Measure # 134 (NQF 0418) Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan:

Community/ Population Health

All patients 12 years and older.

Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen

Patients screened for clinical depression on the date of the encounter using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screen.

Minimum of once per reporting period for patients seen during the reporting period.

G8431 Screening for clinical depression documented as positive AND follow-up plan documented OR G8510 Screening for clinical depression documented as negative, follow-up plan not required. OR G8433 Screening for clinical depression not documented, patient not eligible OR G8940 Screening for clinical depression documented as positive, follow-up plan not documented, patient not eligible. OR G8432 Screening for clinical depression

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form not documented, reason not given OR G8511 Screening for clinical depression documented as positive, follow-up plan not documented reason not given.

Measure # 181 Elder Maltreatment Screen and Follow-Up Plan

Patient Safety

All patients 65 years and older.

Percentage of patients aged 65 years and older with a documented elder maltreatment screen using an Elder Maltreatment Screening Tool on the date of encounter AND a documented follow-up plan on the date of the positive screen.

Patients with a documented elder maltreatment screen using an Elder Maltreatment Screening Tool on the date of the encounter and follow-up plan documented on the date of the positive screen

Once during the reporting period for patients seen during the reporting period.

G8733: Elder maltreatment screen documented as positive AND a follow-up plan is documented

OR G8734: Elder Maltreatment Screen Documented as Negative, Follow-Up Plan not Required

OR

G8535 Elder maltreatment screen not documented; documentation that patient is not eligible for the elder

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form maltreatment screen.

OR G8941 Elder maltreatment screen documented as positive, follow-up plan not documented, patient not eligible for follow-up plan

OR G8536 No documentation of an elder maltreatment screen, reason not given OR G8735 Elder maltreatment screen documented as positive, follow-up plan not documented reason not given.

Measure #226 (NQF 0028) Preventive Care and Screening: Tobacco Use: Screening and Cessation

Community/ Population Health

All patients 18 years and older.

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling

Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling

Once during the reporting period for patients seen during the reporting period.

4004F Patient screened for tobacco use AND received tobacco cessation intervention, if identified as a tobacco user OR

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PQRS Measure Domain Denominator What Needs to Be Determined

Numerator When to Report G code/CPTII- that would be added or pulled from ICANotes to 1500 claim form

Intervention

intervention if identified as a tobacco user.

intervention if identified as a tobacco user

1036F Current tobacco non-user. OR 4004F with 1P Tobacco screening not performed for medical reasons. OR 4004F with 8P Tobacco screening or tobacco cessation intervention not performed reason not otherwise specified. OR 4004F with 8P Screened for tobacco use and identified as a user but did not receive tobacco cessation counseling.

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