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PracticePerspectives
PQRS 2015 Frequently Asked Questions by Clinical Social Workers
SpringI S S U E
2 0 1 5
NASW encourages its members whoare Medicare providers to report thePhysician Quality Reporting System(PQRS) to avoid reductions inreimbursement. In 2017, clinical socialworkers will receive a two percentpenalty for not using PQRS in 2015.The penalty increases in 2017 for notusing PQRS in 2015 when thevalue-based modifier is applied.
PQRS identifies measures that may be used byclinical social workers to improve the qualityof care provided to Medicare beneficiaries.To assist clinical social workers in reportingPQRS, NASW has developed the followingdocument, Reporting Requirements for PQRS2015 for Individual Measures Used byClinical Social Workers, which is available atthe following link: www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf
To help clinical social workers in privatepractice understand how the PQRS programworks, NASW has compiled a list offrequently asked questions by its membersfrom phone calls, emails, and “An Hour WithPrivate Practice: Questions and Answers.”
Q: WHAT IS THE VALUE-BASED MODIFIER?
A: The value-based modifier is a differentialpayment provided to Medicare providers basedon the quality of care furnished compared tocost during the performance. When PQRS issuccessfully reported in 2015, the value-basedmodifier may create a positive paymentadjustment in 2017 whereas lack of PQRSreporting may create an additional negativepayment adjustment in 2017.
Q: WHAT IS A REGISTRY?
A: A registry is one of the mechanisms usedto report PQRS. It is approved by the Centersfor Medicare and Medicaid Services (CMS)to collect and submit PQRS quality data onbehalf of clinical social workers and otherMedicare providers.
Q: IS MEASURE NUMBER 131, PAINASSESSMENT AND FOLLOW-UP, AVAILABLEFOR USE BY CLINICAL SOCIAL WORKERS?
A: In 2015, the Pain Assessment andFollow-Up measure is problematic for clinicalsocial workers because only the psychiatricdiagnostic assessment code, 90791, is listedfor use in the denominator. This measure is tobe reported for each psychiatric service whichcannot be done by reporting a diagnosticassessment code for each therapeutic session.90832, 90834, and 90837 can’t bereported when using this measure.
Mirean Coleman,LICSW, CT
Sen ior Prac t i ce Assoc ia te
750 First Street NE, Suite 800Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 800
Washington, DC 20002-4241
SocialWorkers.org
©2015 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Spring 2015
SocialWorkers.org/Sections800.742.4089
NASWSpecialtyPracticeSections
• FREE CE webinars
• FREE CE credit through InterSections in Practice,the online SPS annual bulletin*
• Cross-Sections highlights stories and information from all 11 practice areas
• SectionLink, providing the latest NASW practicenews six times per year
• e-alerts with timely news, information, and updates
• SectionConnection, practice-specific newsletters*
• Members-only website
• Special Section discounts
PRIVATE PRACTICE SPECIALTY PRACTICE SECTION& CUSTOMIZE THE POWER OF YOUR MEMBERSH IP
JOIN ONLINE TODAY AT SOCIALWORKERS.ORG/SECTIONSor call 202.408.8600 ext. 476.**
*Available online to Sections members only.
**You must be a current NASW member to join a Specialty Practice Section.
JOIN NASW’S
EARN FREE CEs AND KEEP UP-TO-DATE ON PRACTICE ISSUES AND TRENDS:
Q: ARE CLINICAL SOCIAL WORKERS ABLETO REPORT MEASURE NUMBER 46,“MEDICATION RECONCILIATION?”
A: No. Clinical social workers do not meet themeasure description of measure number 46. Thismeasure requires a physician, registered nurse,or clinical pharmacist to reconcile the currentmedication list.
Q: IS MEASURE NUMBER 317 REPORTABLEBY CLINICAL SOCIAL WORKERS? IT IS“PREVENTIVE CARE AND SCREENING:SCREENING FOR HIGH BLOOD PRESSUREAND FOLLOW-UP DOCUMENTED?
A: Measure number 317 requires a bloodpressure to be taken at the time of the office visitand screen for pre-hypertensive or hypertensiveblood pressure. These functions are outside thescope of practice for clinical social workers.
Q: WHAT IS A QUALITY DATA CODE?
A: A quality data code (QDC) identifies a measureused by a Medicare provider to submit PQRSdata via a claims-based or other reporting method.
Q: HOW IS THE QUALITY DATA CODE REPORTED?
A: On the second line following the documentationof psychotherapy services on the CMS-1500form, the quality date code is reported under theheading of CPT/HCPCS on item line 24D.
Q: IS THERE A REPORTING ALTERNATIVEAVAILABLE TO CLINICAL SOCIAL WORKERSWHO HAVE LESS THAN 9 PQRS MEASURESAVAILABLE TO REPORT?
A: For clinical social workers, 1-8 measurescovering 1-3 domains may be reported for thereporting year 2015.
Q: WHAT ARE DOMAINS?
A: Domains are identified by the NationalQuality Strategy (NGS) as a list of 6 prioritiesthat address the most common health concernsthat Americans face: They are:• Patient Safety• Person and Caregiver-Centered Experience
and Outcomes• Communication and Care Coordination• Effective Clinical Care• Community/Population Health• Efficiency and Cost Reduction
Q: WHERE ARE THE DOMAINS REPORTED?
A: The domains are reported in the patient’sclinical record when using PQRS.
Q: HOW DO CLINICAL SOCIAL WORKERSKNOW IF THEIR PQRS INFORMATION WASACCEPTED ON THE CLAIM FORM?
A: On the Explanation of Benefits, the code CO246 N620 is indication that the quality datacode was received into the Centers for Medicareand Medicaid Services (CMS) claims database.
Q: WHAT IS REPORTED FOR CHARGESWHEN USING PQRS?
A: For 2015 charges, report $0.01. This is anon-chargeable fee provided to help ensurequality data codes are processed in the CMSclaims database.
Q: IS PQRS REPORTED ON ALL MEDICARE PATIENTS?
A: PQRS reporting is required on at least 50percent of the Medicare Part B fee-for-servicepatients in your caseload.
Q: WHEN IS THE LAST DAY TO REPORT PQRS?
A: For claims reporting, PQRS must be filed byFebruary 26, 2016. For registry reporting, PQRSmust be filed by March 31, 2016.
Q: ARE THERE PEDIATRIC PQRS MEASURES AVAILABLE FOR USE BYCLINICAL SOCIAL WORKERS?
A: For clinical social workers, Measure Number134 is available for use with children 12 yearsand older. It reads: Preventive Care and Screening:Screening for Clinical Depression and Follow-upPlan. In addition, Measure Number 402 may beused. It reads: Tobacco Use and Help WithQuitting Among Adolescents. The age range is12 to 20 years.
Q: WHAT IS THE MAV PROCESS?
A: The Measure Applicability Validation (MAV)process determines whether clinical socialworkers and other Medicare providers shouldhave reported quality data codes for additionalmeasures and/or NGS domains. It also verifieswhether Medicare providers are reportingcross-cutting measures.
Q: WHAT ARE CROSS-CUTTING MEASURES?
A: Cross-cutting measures draw attention tosymptoms that are important across diagnoses.For PQRS purposes, at least one cross-cuttingmeasure must be reported in a face-to-faceinterview. Cross-cutting measures identified for useby clinical social workers are available at thefollowing link: www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf
Q: HOW MANY PQRS MEASURES AREAVAILABLE FOR USE BY CLINICAL SOCIAL WORKERS?
A: Of the 175 PQRS measures, 8 claims andregistry measures are available for use by clinicalsocial workers. Five of the PQRS measures maybe reported by claims or registry and three of the measures can be reported by registry only.(See the following NASW document, ReportingRequirements for PQRS 2015 for IndividualMeasures Used by Clinical Social Workers,which is available at the following link:www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf.
Q: HOW OFTEN DOES ONE REPORT APQRS MEASURE?
A: Each measure specification lists the reportingcriteria which may vary. The NASW PQRSdocument describes the reporting criteria for eachmeasure available for clinical social workers.
Q: IF PQRS IS NOT REPORTED IN 2015,WILL A PENALTY OCCUR IN 2016?
A: No, the penalty will occur in 2017.
Q: CAN A CLAIM BE RESUBMITTED TOCORRECT PQRS INFORMATION?
A: A claim cannot be resubmitted to correctPQRS information.
Q: IS PQRS ALSO USED WITH A MEDICARE ADVANTAGE PLAN?
A: No, PQRS is reported with MedicareFee-for-Service, Medicare Secondary PayerProgram, and the Railroad Retirement Board.
Q: WHAT ARE MEASURE GROUPS ANDARE THEY AVAILABLE FOR USE BY CLINICALSOCIAL WORKERS?
A: Measure groups are subsets of 6 or morePQRS measures that have a specific clinicalcondition or focus in common. The DementiaMeasures Group may be appropriate for use byclinical social workers using the registry reportingoption. In order to use this measure set, a 20patient sample method must be utilized and allten measures listed in the group must be used foreach of the 20 patients and reported a minimumof once during the reporting period. Additionalinformation about measure group specifications isavailable online at the following link:www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html
Q: ARE THERE ANY MEASURES USED IN2014 THAT CANNOT BE USED IN 2015?
A: Yes, the following three measures were retired:• #106: Adult Major Depressive Disorder
(MDD): Comprehensive DepressionEvaluation: Diagnosis and Severity
• #107: Adult Major Depressive Disorder(MDD) Suicide Risk Assessment
• #248: Substance Use Disorders Screeningfor Depression Among Patients WithSubstance Abuse and Dependence
Q: WHAT HAPPENS IF CLINICAL SOCIALWORKERS WHO ARE MEDICAREPROVIDERS DO NOT REPORT PQRS?
A: In 2015, clinical social workers who do notreport PQRS, will be penalized two percent oftheir Medicare allowable charges in 2017. Theymay receive an additional penalty based on thevalue-based modifier for not using PQRS in 2015.
Q: IS THERE A PQRS HOTLINE AVAILABLETO CALL FOR ASSISTANCE?
A: To assist clinical social workers and otherMedicare providers, CMS offers assistance fromthe Quality Net Help Desk, Monday – Friday,7:00 am – 7:00 pm CST. The phone numbersare 866.288.8912 and TTY: 877.715.6222.The email address is [email protected]
Resources2015 Physician Quality Reporting System (PQRS)Measure Specifications Manual for Claims andRegistry Reporting of Individual Measures. 2014.Chicago: American Medical Association. Availableonline: www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Quality%20Measurement/2015%20PQRS/2015_PQRS_IndividualMeasureSpec_ClaimsRegistry_ 111014.pdf
In 2017, clinical
social workers will
receive a two percent
penalty for not using
PQRS in 2015. The
penalty increases in
2017 for not using
PQRS in 2015 when
the value-based
modifier is applied.
Q: ARE CLINICAL SOCIAL WORKERS ABLETO REPORT MEASURE NUMBER 46,“MEDICATION RECONCILIATION?”
A: No. Clinical social workers do not meet themeasure description of measure number 46. Thismeasure requires a physician, registered nurse,or clinical pharmacist to reconcile the currentmedication list.
Q: IS MEASURE NUMBER 317 REPORTABLEBY CLINICAL SOCIAL WORKERS? IT IS“PREVENTIVE CARE AND SCREENING:SCREENING FOR HIGH BLOOD PRESSUREAND FOLLOW-UP DOCUMENTED?
A: Measure number 317 requires a bloodpressure to be taken at the time of the office visitand screen for pre-hypertensive or hypertensiveblood pressure. These functions are outside thescope of practice for clinical social workers.
Q: WHAT IS A QUALITY DATA CODE?
A: A quality data code (QDC) identifies a measureused by a Medicare provider to submit PQRSdata via a claims-based or other reporting method.
Q: HOW IS THE QUALITY DATA CODE REPORTED?
A: On the second line following the documentationof psychotherapy services on the CMS-1500form, the quality date code is reported under theheading of CPT/HCPCS on item line 24D.
Q: IS THERE A REPORTING ALTERNATIVEAVAILABLE TO CLINICAL SOCIAL WORKERSWHO HAVE LESS THAN 9 PQRS MEASURESAVAILABLE TO REPORT?
A: For clinical social workers, 1-8 measurescovering 1-3 domains may be reported for thereporting year 2015.
Q: WHAT ARE DOMAINS?
A: Domains are identified by the NationalQuality Strategy (NGS) as a list of 6 prioritiesthat address the most common health concernsthat Americans face: They are:• Patient Safety• Person and Caregiver-Centered Experience
and Outcomes• Communication and Care Coordination• Effective Clinical Care• Community/Population Health• Efficiency and Cost Reduction
Q: WHERE ARE THE DOMAINS REPORTED?
A: The domains are reported in the patient’sclinical record when using PQRS.
Q: HOW DO CLINICAL SOCIAL WORKERSKNOW IF THEIR PQRS INFORMATION WASACCEPTED ON THE CLAIM FORM?
A: On the Explanation of Benefits, the code CO246 N620 is indication that the quality datacode was received into the Centers for Medicareand Medicaid Services (CMS) claims database.
Q: WHAT IS REPORTED FOR CHARGESWHEN USING PQRS?
A: For 2015 charges, report $0.01. This is anon-chargeable fee provided to help ensurequality data codes are processed in the CMSclaims database.
Q: IS PQRS REPORTED ON ALL MEDICARE PATIENTS?
A: PQRS reporting is required on at least 50percent of the Medicare Part B fee-for-servicepatients in your caseload.
Q: WHEN IS THE LAST DAY TO REPORT PQRS?
A: For claims reporting, PQRS must be filed byFebruary 26, 2016. For registry reporting, PQRSmust be filed by March 31, 2016.
Q: ARE THERE PEDIATRIC PQRS MEASURES AVAILABLE FOR USE BYCLINICAL SOCIAL WORKERS?
A: For clinical social workers, Measure Number134 is available for use with children 12 yearsand older. It reads: Preventive Care and Screening:Screening for Clinical Depression and Follow-upPlan. In addition, Measure Number 402 may beused. It reads: Tobacco Use and Help WithQuitting Among Adolescents. The age range is12 to 20 years.
Q: WHAT IS THE MAV PROCESS?
A: The Measure Applicability Validation (MAV)process determines whether clinical socialworkers and other Medicare providers shouldhave reported quality data codes for additionalmeasures and/or NGS domains. It also verifieswhether Medicare providers are reportingcross-cutting measures.
Q: WHAT ARE CROSS-CUTTING MEASURES?
A: Cross-cutting measures draw attention tosymptoms that are important across diagnoses.For PQRS purposes, at least one cross-cuttingmeasure must be reported in a face-to-faceinterview. Cross-cutting measures identified for useby clinical social workers are available at thefollowing link: www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf
Q: HOW MANY PQRS MEASURES AREAVAILABLE FOR USE BY CLINICAL SOCIAL WORKERS?
A: Of the 175 PQRS measures, 8 claims andregistry measures are available for use by clinicalsocial workers. Five of the PQRS measures maybe reported by claims or registry and three of the measures can be reported by registry only.(See the following NASW document, ReportingRequirements for PQRS 2015 for IndividualMeasures Used by Clinical Social Workers,which is available at the following link:www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf.
Q: HOW OFTEN DOES ONE REPORT APQRS MEASURE?
A: Each measure specification lists the reportingcriteria which may vary. The NASW PQRSdocument describes the reporting criteria for eachmeasure available for clinical social workers.
Q: IF PQRS IS NOT REPORTED IN 2015,WILL A PENALTY OCCUR IN 2016?
A: No, the penalty will occur in 2017.
Q: CAN A CLAIM BE RESUBMITTED TOCORRECT PQRS INFORMATION?
A: A claim cannot be resubmitted to correctPQRS information.
Q: IS PQRS ALSO USED WITH A MEDICARE ADVANTAGE PLAN?
A: No, PQRS is reported with MedicareFee-for-Service, Medicare Secondary PayerProgram, and the Railroad Retirement Board.
Q: WHAT ARE MEASURE GROUPS ANDARE THEY AVAILABLE FOR USE BY CLINICALSOCIAL WORKERS?
A: Measure groups are subsets of 6 or morePQRS measures that have a specific clinicalcondition or focus in common. The DementiaMeasures Group may be appropriate for use byclinical social workers using the registry reportingoption. In order to use this measure set, a 20patient sample method must be utilized and allten measures listed in the group must be used foreach of the 20 patients and reported a minimumof once during the reporting period. Additionalinformation about measure group specifications isavailable online at the following link:www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html
Q: ARE THERE ANY MEASURES USED IN2014 THAT CANNOT BE USED IN 2015?
A: Yes, the following three measures were retired:• #106: Adult Major Depressive Disorder
(MDD): Comprehensive DepressionEvaluation: Diagnosis and Severity
• #107: Adult Major Depressive Disorder(MDD) Suicide Risk Assessment
• #248: Substance Use Disorders Screeningfor Depression Among Patients WithSubstance Abuse and Dependence
Q: WHAT HAPPENS IF CLINICAL SOCIALWORKERS WHO ARE MEDICAREPROVIDERS DO NOT REPORT PQRS?
A: In 2015, clinical social workers who do notreport PQRS, will be penalized two percent oftheir Medicare allowable charges in 2017. Theymay receive an additional penalty based on thevalue-based modifier for not using PQRS in 2015.
Q: IS THERE A PQRS HOTLINE AVAILABLETO CALL FOR ASSISTANCE?
A: To assist clinical social workers and otherMedicare providers, CMS offers assistance fromthe Quality Net Help Desk, Monday – Friday,7:00 am – 7:00 pm CST. The phone numbersare 866.288.8912 and TTY: 877.715.6222.The email address is [email protected]
Resources2015 Physician Quality Reporting System (PQRS)Measure Specifications Manual for Claims andRegistry Reporting of Individual Measures. 2014.Chicago: American Medical Association. Availableonline: www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Quality%20Measurement/2015%20PQRS/2015_PQRS_IndividualMeasureSpec_ClaimsRegistry_ 111014.pdf
In 2017, clinical
social workers will
receive a two percent
penalty for not using
PQRS in 2015. The
penalty increases in
2017 for not using
PQRS in 2015 when
the value-based
modifier is applied.
PracticePerspectives
PQRS 2015 Frequently Asked Questions by Clinical Social Workers
SpringI S S U E
2 0 1 5
NASW encourages its members whoare Medicare providers to report thePhysician Quality Reporting System(PQRS) to avoid reductions inreimbursement. In 2017, clinical socialworkers will receive a two percentpenalty for not using PQRS in 2015.The penalty increases in 2017 for notusing PQRS in 2015 when thevalue-based modifier is applied.
PQRS identifies measures that may be used byclinical social workers to improve the qualityof care provided to Medicare beneficiaries.To assist clinical social workers in reportingPQRS, NASW has developed the followingdocument, Reporting Requirements for PQRS2015 for Individual Measures Used byClinical Social Workers, which is available atthe following link: www.socialworkers.org/assets/secured/documents/practice/clinical/PRA-NL-12915.PQRS-PP.pdf
To help clinical social workers in privatepractice understand how the PQRS programworks, NASW has compiled a list offrequently asked questions by its membersfrom phone calls, emails, and “An Hour WithPrivate Practice: Questions and Answers.”
Q: WHAT IS THE VALUE-BASED MODIFIER?
A: The value-based modifier is a differentialpayment provided to Medicare providers basedon the quality of care furnished compared tocost during the performance. When PQRS issuccessfully reported in 2015, the value-basedmodifier may create a positive paymentadjustment in 2017 whereas lack of PQRSreporting may create an additional negativepayment adjustment in 2017.
Q: WHAT IS A REGISTRY?
A: A registry is one of the mechanisms usedto report PQRS. It is approved by the Centersfor Medicare and Medicaid Services (CMS)to collect and submit PQRS quality data onbehalf of clinical social workers and otherMedicare providers.
Q: IS MEASURE NUMBER 131, PAINASSESSMENT AND FOLLOW-UP, AVAILABLEFOR USE BY CLINICAL SOCIAL WORKERS?
A: In 2015, the Pain Assessment andFollow-Up measure is problematic for clinicalsocial workers because only the psychiatricdiagnostic assessment code, 90791, is listedfor use in the denominator. This measure is tobe reported for each psychiatric service whichcannot be done by reporting a diagnosticassessment code for each therapeutic session.90832, 90834, and 90837 can’t bereported when using this measure.
Mirean Coleman,LICSW, CT
Sen ior Prac t i ce Assoc ia te
750 First Street NE, Suite 800Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 800
Washington, DC 20002-4241
SocialWorkers.org
©2015 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Spring 2015
SocialWorkers.org/Sections800.742.4089
NASWSpecialtyPracticeSections
• FREE CE webinars
• FREE CE credit through InterSections in Practice,the online SPS annual bulletin*
• Cross-Sections highlights stories and information from all 11 practice areas
• SectionLink, providing the latest NASW practicenews six times per year
• e-alerts with timely news, information, and updates
• SectionConnection, practice-specific newsletters*
• Members-only website
• Special Section discounts
PRIVATE PRACTICE SPECIALTY PRACTICE SECTION& CUSTOMIZE THE POWER OF YOUR MEMBERSH IP
JOIN ONLINE TODAY AT SOCIALWORKERS.ORG/SECTIONSor call 202.408.8600 ext. 476.**
*Available online to Sections members only.
**You must be a current NASW member to join a Specialty Practice Section.
JOIN NASW’S
EARN FREE CEs AND KEEP UP-TO-DATE ON PRACTICE ISSUES AND TRENDS: