summer issue practiceperspectives · 2014. 6. 25. · 134 is available for use with children 12...
TRANSCRIPT
PracticePerspectives
PQRS Frequently Asked Questions by Clinical Social Workers
SummerI S S U E
J U N E2 0 1 4
During 2014, clinical social workerswho are Medicare providers shoulddemonstrate quality care by reporting thePhysician Quality Reporting System(PQRS) or receive a two percent penaltyin 2016 for not using PQRS. The penaltyincreases each year PQRS is not used.PQRS identifies measures that may beused by clinical social workers toimprove the quality of care provided toMedicare beneficiaries. To assist clinicalsocial workers in reporting PQRS, NASWhas developed the following document,Using Medicare PQRS 2014 IndividualMeasures in Clinical Practice, which isavailable online at the following link:www.socialworkers.org/practice/clinical/
WKF-NL-25114.UsingMedicarePP.pdf.
NASW has complied a list of frequently asked questions by its members from “An Hour With Private Practice: Questions andAnswers,” to help other clinical social workersin private practice understand how the PQRSprogram works.
Q: What is a quality data code?A: A quality data code (QDC) identifies a
measure used by a Medicare provider tosubmit PQRS data via a claims-based orother reporting method.
Q: How is the quality data code reported?A: On the second line following the
documentation of psychotherapy serviceson the CMS-1500 form, the quality datacode is reported under the heading ofCPT/HCPCS on item line 24D.
Q: Is there a reporting alternative available toclinical social workers who have less thannine PQRS measures available to report?
A: For clinical social workers, 1-8 measurescovering 1-3 domains may be reported.
Q: What are domains?A: Domains are identified by the National
Quality Strategy as a list 6 priorities thataddress 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
Mirean Coleman, L ICSW, CT
Sen ior Prac t i ce Assoc ia te
750 First Street NE, Suite 700Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 700
Washington, DC 20002-4241
SocialWorkers.org
©2014 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Summer June 2014
Q: Where are the domains reported?A: The domains are reported in the patient’s
clinical record when using PQRS.
Q: How do clinical social workers know iftheir PQRS information was accepted onthe claim form?
A: On the Explanation of Benefits, denial codeN365 is indication that the quality data codewas received into the Centers for Medicareand Medicaid Services (CMS) claimsdatabase. N365 reads, “This procedure codenot payable. It is for reporting/informationpurposes only.” Effective July 1, 2014,N365 will be replaced by N620.
Q: What is reported for charges when usingPQRS?
A: For 2014 charges, report $0.01. This is anon-chargeable fee provided to help ensurequality data codes are processed in theCMS claims database.
Q: Is PQRS reported on all patients?A: PQRS reporting is required on at least 50
percent of the Medicare Part B fee-for-servicepatients in your caseload.
Q: When is the last day to report PQRS?A: For 2014, PQRS must be filed by
February 27, 2015.
Q: Are there pediatric PQRS measuresavailable for use by clinical social workers?
A: For clinical social workers, Measure Number134 is available for use with children 12years and older. It reads: Preventive Careand Screening: Screening for ClinicalDepression and Follow-up Plan.
Q: Is Measure Number 131, Pain Assessmentand Follow-Up, available for use by clinicalsocial workers?
A: In 2014, the Pain Assessment and Follow-Upmeasure is problematic for clinical socialworkers because only the psychiatricdiagnostic assessment code is listed for usein the numerator. This measure is to bereported for each psychiatric service whichcannot be done by reporting a diagnosticassessment code for each therapeutic session.
Q: How many PQRS measures are availablefor use by clinical social workers?
A: Of the 110 PQRS claim measures, 8 measuresare available for use by clinical social workers.
Q: How often does one report a PQRSmeasure?
A: Each measure specification lists the reportingcriteria which may vary. The NASW PQRSdocument describes the reporting criteria foreach measure available for use by clinicalsocial workers.
Q: Can a claim be resubmitted to correctPQRS information?
A: A claim cannot be resubmitted to correctPQRS information.
Q: Is PQRS also used with a MedicareAdvantage Plan?
A: No, PQRS is reported with MedicareFee-for-Service, Medicare Secondary PayerProgram, and the Railroad Retirement Board.
Q: Are clinical social workers able to reportMeasure Number 247: Substance UseDisorder Counseling Regarding Psychosocialand Pharmacologic Options for AlcoholDependence?
A: Measure Number 247 is not recommendedfor use by clinical social workers becausepharmacologic treatment is not within thescope of practice for clinical social workers.
Q: What happens if clinical social workers whoare Medicare providers do not report PQRS?
A: In 2014, clinical social workers who do notreport PQRS, will be penalized two percentof their Medicare allowable charges in 2016.
Q: Is there a PQRS hotline available to call for assistance?
A: To assist clinical social workers and otherMedicare providers, CMS offers assistancefrom the Quality Net Help Desk, Monday –Friday, 7:00 am – 7:00 pm CST. The phonenumbers are 866.288.8912 and TTY:877.715.6222. The email address [email protected]
Resources2014 Physician Quality Reporting System (PQRS):Claims Reporting Made Simple. Available online at:www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014PQRS_SatisfRprtng-Claims_F11-26-2013.pdf
PracticePerspectives
PQRS Frequently Asked Questions by Clinical Social Workers
SummerI S S U E
J U N E2 0 1 4
During 2014, clinical social workerswho are Medicare providers shoulddemonstrate quality care by reporting thePhysician Quality Reporting System(PQRS) or receive a two percent penaltyin 2016 for not using PQRS. The penaltyincreases each year PQRS is not used.PQRS identifies measures that may beused by clinical social workers toimprove the quality of care provided toMedicare beneficiaries. To assist clinicalsocial workers in reporting PQRS, NASWhas developed the following document,Using Medicare PQRS 2014 IndividualMeasures in Clinical Practice, which isavailable online at the following link:www.socialworkers.org/practice/clinical/
WKF-NL-25114.UsingMedicarePP.pdf.
NASW has complied a list of frequently asked questions by its members from “An Hour With Private Practice: Questions andAnswers,” to help other clinical social workersin private practice understand how the PQRSprogram works.
Q: What is a quality data code?A: A quality data code (QDC) identifies a
measure used by a Medicare provider tosubmit PQRS data via a claims-based orother reporting method.
Q: How is the quality data code reported?A: On the second line following the
documentation of psychotherapy serviceson the CMS-1500 form, the quality datacode is reported under the heading ofCPT/HCPCS on item line 24D.
Q: Is there a reporting alternative available toclinical social workers who have less thannine PQRS measures available to report?
A: For clinical social workers, 1-8 measurescovering 1-3 domains may be reported.
Q: What are domains?A: Domains are identified by the National
Quality Strategy as a list 6 priorities thataddress 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
Mirean Coleman, L ICSW, CT
Sen ior Prac t i ce Assoc ia te
750 First Street NE, Suite 700Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 700
Washington, DC 20002-4241
SocialWorkers.org
©2014 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Summer June 2014