All Your PQRS Questions Answered

All Your PQRS Questions Answered

Each week I receive numerous questions regarding the Physician Quality Reporting System (PQRS).  This article is meant to answer many of these questions.  

1.  What is PQRS?

The Tax Relief and Healthcare Act of 2006 established PQRS.  This reporting system gives eligible providers, who successfully participate in PQRS between 2011-2014, incentive payments for reporting data on quality measures to Medicare.  The purpose of PQRS is to collect data for Medicare’s value-based modifier initiative.  CMS will use PQRS results to calculate value-based modifiers by 2017.

2.  Is PQRS mandatory?

PQRS is mandatory if you wish to avoid penalties.  All chiropractors who are providers (Par or Non-Par) for Medicare are required to participate in 2013, in order to avoid a reimbursement penalty of 1.5% in 2015.  Additionally, failure to report in 2104 will result in a reimbursement penalty of 2% in 2016 and thereafter.  This may not seem like much, but if you make $2000.00 a month on Medicare visits; a decrease in payments will cost your office $360.00 in 2015 and $480.00 in 2016 and thereafter. 

3.  Is there an incentive for participating in PQRS?

 Yes!  When a provider properly reports PQRS data to Medicare in 2013 he/she will receive a 0.5% payment bonus (this includes deductibles and coinsurance amounts).  When Medicare is the secondary payer, PQRS payments are not limited to the paid Medicare portion but the entire allowed fee.   Although this is not a large sum of money, you can earn extra money for something you need to be doing to avoid penalties at a later date.   

4.  Do I have to register for PQRS?

No.  You do not have to register.  You just need to start using the proper G codes on your claim form to show that you are participating.  It is not hard to report.

5.  How often do PQRS G codes need to be reported?

Measures 131 and 181 need to be reported on every visit for every Medicare patient (at least 18 years old) when reporting CPT® code 98940, 98941 and 98942.  In 2013, both measures must be successfully reported at least 50% of the time and successfully performed each measure at least once to qualify for a bonus and avoid future penalties.      

6.  What are the G codes that chiropractors are required to report?

 Chiropractors need to report on only two quality measures: Measure 131: Pain Assessment and Follow-up and Measure 182: Functional Outcome Assessment.  However, there are several G-Codes for each measure.G-codes for reporting Measure 131

CODE 
Reason
G8730
Pain assessment documented as positive utilizing a standardized tool and follow-up plan is documented
G8731
Pain assessment documented as negative, no follow-up plan needed
G8939
Pain assessment documented (positive pain), follow-up plan not documented because patient not eligible for one of the following reasons:
•  Severe mental and/or physical incapacity where the person is unable to express self in a manner understood by others
•  The patient is in an urgent or emergent situation where a delay of treatment would jeopardize the patient’s health
G8442
Documentation that the patient is not eligible for pain assessment for one of the same reasons as G8939
G8732
No documentation of pain assessment, reason not given
G8509
Documentation of positive pain assessment; no documentation of a follow-up, reason not given (the pain was present but no documented follow-up plan or a reason the patient was not eligible)

The purpose of measure 131 is for CMS to collect information on when pain assessments are conducted using a standardized tool and reassessment is planned when the patient is present.

G-Codes for reporting Measure 182

CodeReason
G8539
Documentation of a functional outcome assessment using a standardized tool AND documentation of a care plan based on identified deficiencies on the date of the functional outcome assessment (treatment plan must include goals).
G8540
Documentation that the patient is not eligible for a functional outcome assessment using a standardized tool.
Reasons:
• The patient refuses to participate
• The patient is unable to complete the questionnaire
G8541
Functional outcome assessment using a standardized tool not documented, reason not given.
G8542
Documentation of a functional outcome assessment using a standardized tool; no functional deficiencies identified, care plan not required (Documented reason: no functional deficiencies).
G8543
Documentation of a functional outcome assessment using a standardized tool; care plan not documented, (reason not given).
G8942
Documented functional outcome assessment and care plan within the previous 30 days. A functional outcome assessment, using a standardized tool and a treatment plan is in the patient’s file.

The purpose of this measure is to utilize a functional outcome assessment tool at a minimum of every 30 days. Reporting is still required for each visit.  Visits occurring within 30 days of a previously documented functional outcome assessment should report code G8942.      

The purpose of this measure is to utilize a functional outcome assessment tool at a minimum of every 30 days. Reporting is still required for each visit.  Visits occurring within 30 days of a previously documented functional outcome assessment should report code G8942.      

7.  What standardized pain assessment tools can be used to measure 131?

Standardized pain assessment tools include but not limited to: Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS), and Visual Analog Scale (VAS).

8.  What standardized functional outcome tools can be used for measure 182?

Standardized functional outcome assessment tools include the Oswestry Disability Index (ODI), Roland Morris Disability/Activity Questionnaire (RM), Neck Disability Index (NDI) and Physical Mobility Scale (PMS). Documentation of a current functional outcome assessment must include identification of the standardized tool used.

9.  How do I report the G codes on the 1500 paper claim form or electronic claim form?

On the paper claim form, the G-codes are reported on line 24D.  On the electronic claim form, the G-codes are reported on service line 24.  G codes should be reported with a zero-dollar amount.  However, if your office software does not allow for this, one can use a nominal amount of $0.01.

10. How do I know if Medicare has successfully received my PQRS codes?

An N365 code should appear on your EOB.  

If you haven’t started reporting PQRS G codes time is running out to avoid penalties in 2105 and thereafter.   If you are already reporting PQRS G codes great, you are probably on your way to receiving a bonus and avoiding future penalties.

About Author

ICS Staff

The Illinois Chiropractic Society staff works collaboratively on many topics to bring the most comprehensive and relevant information to our members. We have over 60 years of chiropractic experience and understand the heartbeat of the profession. We all look forward to providing relevant information to our members for years to come.

Leave a reply

Recent Videos

Loading...

Corporate Club

Slider

Article Categories