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PQRS Tutorial
(Posted to Listserve on March 17, 2016 by Deborah Okon)

**The PQRS requirement only applies to patients who have Medicare Fee For Service (i.e., you file claims to Novitas-Solutions)**

Note: Providers who choose to not bother with PQRS in 2016 will receive a 2% penalty cut in fees paid by Novitas in 2018.  That amounts to about a $2.50 fee reduction for each 90837 you provide.

Filing is simple; simply add a claim line when you file your claim to Novitas.  You also can pay to use a Registry to file your PQRS, but why spend $199 a year?

To avoid the penalty, at minimum, you must report one cross cutting measure for at least 50% of your Novitas patients.  They would like us to report 9 codes, but there are very few relevant to mental health providers, especially if you file HCFA claims or EHR claims.

The one link you must use:
Find “New for 2016" “web based tool.”

Step One
Write down all of the Medicare FFS patients you have seen this calendar year.  To complete step three, you will at minimum need their age and diagnosis.

Step Two:  
Go to the “web based tool” and filter for the reporting method that is appropriate for your practice (e.g., CLAIMS, EHR, or REGISTRY).  The filter YES for cross-cutting.  Find at least one measure on the list that you do for just about every Novitas (i.e., Medicare fee for service) patient that you treat.
Note: For BMI, YOU must measure their height and weight.
-For Medications, you must document them every visit.
-For depression screening, you must use a standardized screening tool.
-For Pain assessment, you must use a standardized screening tool for each visit.
-For Tobacco use, you simply must ask them once every 24 months if they use or don’t use, and if they do use, you must spend up to 3 minutes intervening, and document it in their progress note.  Then you must add the PQRS code as a claim line one time in 2016.

Step Three:  Figure out the relevant code for your particular patient.  Using the same web-based tool, click on a measure and then read down to figure out the appropriate code to enter when you file your claim. 

4004F Tobacco user and intervened
1036F Tobacco non-user
Step Four:  
Add the PQRS line(s) when you submit your claim.  Bill the "service" at one cent (that's $.01).  In theory, you can file a claim the PQRS code even if you billed for the session earlier in the year. Go back and remember when you did the PQRS "measure" work and list that as DOS.  Make sure to do this before the end of the reporting period (i.e., Dec 31).

Step Five:  Figure out how you will spend all that extra money in 2018 since you weren’t penalized after all!

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