Eli's Rehab Report

Published on Fri Jan 18, 2008 PDF

Despite bonus payment issues, experts recommend you get involved if you can.

Get ready to jump on the PQRI train in 2009. If you're a physical or occupational therapist in a private practice setting, you can participate in the physician quality reporting initiative, and your bonus incentive will increase from 1.5 percent to 2 percent, according to the 2009 Medicare Physician Fee Schedule Final Rule.

Get Up to Speed on Newest Quality Measures The MPFS listed the following as measures reportable by either PTs, OTs, or both in 2009.

• Falls: Plan of Care

• Falls: Risk Assessment

• Documentation and Verification of Current Medications in the Medical Record

• Screening for Clinical Depression

• Pain Assessment Prior to Initiation of Patient Therapy

• Body Mass Index Screening and Follow-up: Preventive Care and Screening

• Health Information Technology: Adoption/Use of Electronic Health Records

• Inquiry Regarding Tobacco Use: Preventive Care and Screening

• Unhealthy Alcohol Use: Screening and Brief Counseling, Preventive Care, and Screening

• Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological Evaluation

• Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear.

CMS deleted the Screening for Future Fall Risk and replaced it with two more specific measures on falls, points out Sharmila Sandhu, Esq., regulatory counsel for the American Occupational Therapy Association. So make sure you don't report the old falls measure. CMS also deleted the Patient Co-Development of Treatment Plan/Plan of Care measure.

Important: Check with CMS to find out which measures are applicable to just PTs, just OTs, or both, by reading the measures specifications at www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp.

The MPFS Final Rule did not change how you're required to report PQRI measures, confirms Gayle Lee, JD, director of regulatory affairs for the American Physical Therapy Association.

As usual, you'll enter the measure's "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).

Remember: CMS will not accept a quality data code unless it's linked to a CPT code - and that CPT code has to be on CMS' list of CPT codes that link to the measure. See the Web page above for more information on linked codes, which CMS should be releasing soon. Stay tuned to upcoming issues of Physical Medicine & Rehab Coding Alert for more on 2009 measures specifications.

Also, you must perform -- and document -- a quality measure 80 percent of the time it's applicable. And your practice must successfully report on at least three quality measures to qualify for the bonus, Lee points out.

If you've been dutifully and correctly reporting your PQRI measures and are still having trouble getting your bonus payment, you're not alone. But don't give up. "We're encouraging people to participate because we don't see PQRI going away, especially with the new presidential administration coming in and the Baucus plan," Lee said. (See the related news story on page 7 for more information) "There's an increasing focus on quality, so even if therapists aren't getting paid, they need to be prepared for the direction the future is taking."

The good news: CMS has made its information on PQRI more accessible on its Web site, as mandated in the MPFS Final Rule, Lee points out. Also, CMS will be posting a report before the end of 2008 that investigates why people haven't been getting paid properly and why people are having a hard time accessing their feedback reports, Lee tells Eli.

As for non-private practice settings, keep your fingers crossed. CMS still hasn't approved a registry reporting system for therapists, Sandhu says. "But AOTA will continue to work with CMS on a solution for that." In addition, CMS has been working with the company Cederon regarding that topic.

Don't miss: SLPs have been eligible for PQRI, but they don't have any reportable measures yet, says Ingrida Lusis with the American Speech-Language Hearing Association. "Unfortunately, SLPs received private practice status after all the PQRI proposals came out, but meanwhile we're working on getting CMS to use ASHA's NOMS measures for PQRI 2010."

Also, audiologists just received PQRI eligibility, Lusis says, and ASHA is already at work developing proposals for their quality measures.