Eli's Rehab Report

Published on Wed Jan 20, 2010 PDF

Good news: SLPs and audiologists get measures to report this year.

The 2010 Medicare Physician Fee Schedule brought more than just new code values for this coming year -- it updated the Physician Quality Reporting Initiative (PQRI) as well. See what's new for rehab so you can cash in on a bonus if you're in a private practice setting.

Physical and occupational therapists will not see new measures to report this year, experts confirm. But you should be aware of what's going on behind the scenes. For one, the professional associations are working hard to get registry reporting systems running and approved so that rehab professionals in settings besides private practices can participate in PQRI.

Example: The American Occupational Therapy Association (AOTA) is working with the company, Cedaron, which has a system in place to electronically report PQRI measures, says Chuck Willmarth, director of reimbursement and regulatory policy for AOTA. The system is not complete yet, but the Centers for Medicare & Medicaid Services (CMS) recognizes Cedaron as a PQRI reporting registry.

Another PQRI development is the possibility of more occupational therapy measures in 2011. "Many of the OTs in private practice are hand therapists -- and the measures we have available at the moment are not specific to hand therapy," Willmarth points out.

The good news: "We recently learned that Quality Insights of Pennsylvania is reconvening their expert workgroup," Willmarth says. This company was in the middle of getting four new quality measures for OTs endorsed for PQRI when its contract ran out. Now, AOTA hopes to see these measures move forward for 2011.

In other news, the American Medical Association and other healthcare professionals met with CMS about PQRI and brought up the agency's excessive lag time for giving feedback, according to Jennifer Hitchon, JD, MHA, regulatory counsel for AOTA, who attended the meeting. "Dr. Rapp [director of quality measurement and health assessment for the CMS Office of Clinical Standards and Quality] said the agency would really take the lag time into consideration and encouraged anyone with questions on reporting measures to call the help desk."

The help desk number is 1-866-288-8912.

Also of note: Funding for PQRI lasts only through 2010, Willmarth points out. "Part of the PQRI funding is linked with healthcare reform, so funding for it in the future depends on what happens with Congress."

Speech-language pathologists (SLPs) were eligible PQRI participants in 2009 but had no discipline-applicable measures to report. But CMS added 16 new measures for SLPs to report in 2010. "SLPs will be able to report outcomes for stroke patients in eight functional domains: spoken language comprehension, reading, spoken language expression, writing, motor speech, swallowing, attention, and memory," confirms Mark Kander, director of health care regulatory analysis for the American Speech-Language Hearing Association (ASHA).

Audiologists will also have three measures available to report in 2010, Kander says.

Key: All eight PQRI measures for SLPs are functional measures derived from ASHA's National Outcomes Measurement System (NOMS), explains Kate Romanow, JD, director of health care regulatory advocacy for ASHA.

The catch: "Currently, Medicare claim forms do not contain codes for the eight approved quality measures for SLPs," says Jaumeiko Coleman, PhD, CCC-SLP, associate director of N-CEP for ASHA. So you must report the SLP measures via registry instead. NOMS, ASHA's registry, is the only vehicle through which one can submit functional communication measures.

"ASHA recently applied for NOMS to become Medicareapproved, and ASHA hopes to hear from CMS about the approval status by mid-2010," Coleman says. "We encourage SLPs eligible for PQRI to report data associated with the approved measures to NOMS, despite the current approval status of NOMS as a Medicare-approved registry."

Bottom line: SLPs must enroll in NOMS and get training in the NOMS "seven-level functional progress scale" in order to participate in PQRI, Kander says.

If you're eligible to report PQRI make sure you're properly reporting your measures so you can cash in on your 2 percent bonus. This is 2 percent of all allowed charges for covered Medicare Part B services.

• Use the proper quality data code CMS assigned the measure when you report it.

• Make sure you include a relevant CPT code, or "denominator code" to validate the quality data code.

• Watch for cases where the PQRI measure requires a diagnosis code present.

• Enter the quality data code as a separate line item on the claim form, and mark it with a charge of $0.00 (or $0.01 if your billing software doesn't accept zero charges).

• Be sure to report at least three quality measures, and for each measure cover at least 80 percent of the patient population CMS assigns to the measure.