How to use Falcon Physician to meet the measures | August 2014

How to use Falcon Physician to meet the measures | August 2014

PQRS 2014

What is PQRS?

Physician Quality Reporting System

A reporting program, mandated by federal legislation, that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals.

Who Needs to Report

Do I need to report PQRS for 2014?

Yes – all physicians/ eligible providers need to report PQRS in 2014 to avoid a penalty in 2016 and beyond.

***If you report and do not qualify for an incentive – reporting three measure will prevent incurring a penalty.

***Falcon will report for ALL physicians to ensure they will not incur a penalty. (Based on the return of the PQRS consent form which will be distributed in late 2014).

Eligible providers report separately….individually through the registry method. Just as they do for Meaningful Use.

What do I Get?

Incentive $ = 0.5% of Medicare allowed charges.

What If I Do Not Report for 2014?

Penalty for 2016: Is a payment adjustment = 2%

Incentive or Penalty

The Measures

What are the PQRS Measures?

Falcon has chosen a small number of measures that are applicable to Nephrologists AND made it easy for you to report directly on the Superbill under the Quality Measures button.

Falcon Physician is a certified Registry for reporting PQRS so we will be pulling the data from Falcon at the end of the year and reporting the measures through our registry for each provider that consents to the submission of their data and qualifies.

Reporting Individual MeasuresAt the end of the year, report either:Minimum of 9 of the Individual measures for 1 Yr (1/1/14-12/31/14)

Minimum to report = 50% of Medicare Part B patients (primary or secondary)Earn Incentive $ = .5% of 1 yr of Medicare FFS

Individual Measures (Report 9):#1 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus (Checkbox on Superbill)#2 Diabetes Mellitus: LDL-C Control in Diabetes Mellitus (CQM NQF #64) (Checkbox on Superbill)#110 Preventive Care and Screening: Influenza Immunization (Checkbox on Superbill)#111 Pneumonia vaccine 65+ (Checkbox on Superbill) #121 Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Checkbox on Superbill)#122 Adult Kidney Disease: Blood Pressure Management (CQM NQF #61) (Checkbox on Superbill)#123 Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Checkbox on Superbill)#128 Preventive Care and Screening: BMI Screening and Follow-up (CQM NQF #421) (Checkbox on Superbill)#130 Documentation of Meds (NQF#0419) (Checkbox on Superbill) #226 Preventive Care and Screening: Tobacco Use: Screening & Cessation Intervention (CQM NQF #28) #236 Hypertension: BP Management (NQF#18) (Checkbox on Superbill)#317 High BP Screening (NQF#TBD) (Checkbox on Superbill)

Reporting Group Measures

.

All of the CKD Group Measures for 1 Yr or 6 monthsMinimum to report = 20 unique patients (primary or secondary)Earn Incentive $ = .5% of 1 yr or 6 months of Medicare

FFS Measures we selected do not include Dialysis E & M codes so Dialysis patients seen IN CENTER are not included for PQRS Measures in Falcon.Participating eligible professional must report on all applicable measures within the selected measures group for a minimum sample of 20 unique patients, a majority (11) of which must be Medicare Part B FFS patients, who meet patient sample criteria for the measures group. If the eligible professional does not have at least 20 unique patients who meet patient sample criteria for the measures group, the eligible professional will need to choose another reporting option.All applicable measures within the group must be reported at least once for each patient within the sample population seen by the eligible professional during the reporting period (January 1 through December 31, 2014 OR July 1 through December 31, 2014) for each of the 20 unique patients

#110 Preventive Care and Screening: Influenza Immunization (Checkbox on Superbill)#121 Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Checkbox on Superbill)#122 Adult Kidney Disease: Blood Pressure Management (CQM NQF #61) (Checkbox on Superbill)#123 Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Checkbox on Superbill)

Individual Measures

Individual Measures

Report on 9 of these measures (1 year reporting period):

#1 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus#2 Diabetes Mellitus: LDL-C Control in Diabetes Mellitus#110 Preventive Care and Screening: Influenza Immunization (Group Measure )#111 Pneumonia vaccine 65+#121 Adult Kidney Disease: Laboratory Testing (Lipid Profile) (Group Measure )#122 Adult Kidney Disease: Blood Pressure Management (Group Measure )#123 Adult Kidney Disease: Patients on ESA – Hgb Level > 12.0 g/dL (Group Measure )#128 Preventive Care and Screening: BMI Screening and Follow-up#130 Documentation of Meds#226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention#236 Hypertension: BP Management #317 High BP Screening

Individual Measures – how many?

50% of Medicare Part B patients need to be reported for each measure.

You can check the denominators and numerators for each measure in your Quality Scorecard.

To meet the incentive you will need to meet 9 individual measures across 3 domains. In order to avoid the penalty you will need to submit on 3 valid measures displaying at least one Medicare Part B patient.

Use the Medicare Part B report in Falcon to ensure you have least one Medicare B patient in a Measure.

Individual Measures – on the Superbill

Measures in Review - #1 (Individual)

#1 (NQF 0059): Diabetes Mellitus: Hemoglobin A1c Poor Control

Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0% (reverse measures – so less performance (less in numerator) is better)

Denominator = Seen in the reporting period AND age 18 to 75 yrs ANDOne of the Diabetes Mellitus ICD code entered in Problem List:

250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51,250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81,250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05,362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04

Numerator = Most recent Hgb A1c >9.0% Quality Measures button in the Superbill- Check box for #1 - ORLab Result for Hemoglobin A1c entered in Falcon (Interfaced or Manually entered)

OR Use 3045F: Most Recent hemoglobin A1c level between 7 and 9Use 3046F: to indicate the most recent hemoglobin A1c level > 9.0%

Measures in Review - #2 (Individual)#2 (NQF 0064): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control

Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent LDL-C level in control (less than 100 mg/dL)

Denominator = Seen in the reporting period AND age 18 to 75 yrs ANDOne of the Diabetes Mellitus ICD code entered in Problem List:

250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51,250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81,250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05,362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04

Numerator = LDL-C < 100 mg/dl - Quality Measures button in the Superbill- Check box for #2

ORLab Result for LDL-C entered in Falcon (Interface or Manually entered)

OR Use 3048F: to indicate Most recent LDL-C < 100 mg/dL


#110 (NQF 0041): Preventive Care and Screening: Influenza ImmunizationPercentage of patients aged 6 months and older seen for a visit between October 1 and March

31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Measure #110 only needs to be reported a minimum of once during the reporting period when the patient’s visit included in the patient sample population is between January and March for the 2013-2014 influenza season OR between October and December for the 2014-2015 influenza season. When the patient’s office visit is between April and September, Measure #110 is not applicable and will not affect the eligible provider’s reporting or performance rate.

Denominator = Patients > 6 mos. old AND Office Visit with valid E & M Code AND Visit is between Jan – Mar 2014 OR Oct – Dec 2014.

Numerator = Quality Measures button in the Superbill- Check box for #110 ORUse CPT code G8482: Influenza immunization administered or previously received

Measures in Review - #111 (Individual)#111 (NQF 0043): Pneumonia Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

Denominator = Seen in the reporting period AND are age > 65 yrs.

Numerator = Patients who have ever received a pneumococcal vaccination

Quality Measures button on the superbill - Check the box in the superbill - Check box for #111 OR Use CPT II 4040F: Pneumococcal vaccine administered or previously received in the procedures

section of your encounter. OR Pneumococcal Vaccination not Administered or Previously Received, Reason not Otherwise

Specified Use CPTII 4040F with Modifier 8P in the procedures section of your encounter.


#121: Adult Kidney Disease: Laboratory Testing (Lipid ProfilePercentage of patients aged 18 years and older with a diagnosis of CKD (stage 3, 4

or 5, not receiving Renal Replacement Therapy [RRT]) who had a fasting lipid profile performed at least once within a 12-month period

Denominator = Patient with CKD 3, 4 or 5 diagnosis code AND Patients > 18 yrs. old AND Office Visit w/ valid E & M CodeNumerator = Quality Measures button in the Superbill- Check box for #121 ORLab Test Results for Lipid Profile (Interface or Manually entered)

ORUse CPT code G8725: Fasting lipid profile performed (Triglycerides, LDL-C, HDL-C, and Total Cholesterol)


#122: Adult Kidney Disease: Blood Pressure ManagementPercentage of patient visits for those patients aged 18 years and older with a diagnosis of CKD (stage 3, 4 or 5, not receiving Renal Replacement Therapy [RRT]) and documented proteinuria with a blood pressure< 130/80 mmHg OR ≥ 130/80 mmHg with a documented plan of care

Plan of Care - A documented plan of care should include one or more of the following: recheck blood pressure within 90 days; initiate or alter pharmacologic therapy for blood pressure control; initiate or alter non-pharmacologic therapy (lifestyle changes) for blood pressure control; documented review of patient’s home blood pressure log which indicates that patient’s blood pressure is or is not well controlled

Denominator = Patient with CKD 3, 4 or 5 diagnosis code AND Patients > 18 yrs. old AND Office Visit with valid E & M Code AND Proteinuria (791.0) in the patient Problem List.Numerator = Enter Vitals into Vitals section OR Quality Measures button in the Superbill- Check box for #122 (checking the box indicates you documented a Plan of Care if required) ORUse G8476: to indicate the most recent blood pressure has a systolic measurement of < 130 mmHg and a diastolic measurement of < 80 mmHgG8477: Most recent blood pressure has a systolic measurement of ≥ 130 mmHg and/or a diastolic measurement of ≥ 80 mmHg

AND Use CPT 0513F: to indicate elevated BP plan of care documented


#123: Adult Kidney Disease: Patients On Erythropoiesis-Stimulating Agent (ESA) - Hemoglobin Level > 12.0 g/dLPercentage of calendar months within a 12-month period during which a hemoglobin level is measured for patients aged 18 years and older with a diagnosis of advanced CKD (stage 4 or 5, not receiving RRT [Renal Replacement Therapy]) or End Stage Renal Disease (ESRD) (who are on hemodialysis or peritoneal dialysis) who are also receiving ESA therapy AND have a hemoglobin level > 12.0 g/dL

Denominator = Patient with CKD 4 or 5 diagnosis code AND Patients > 18 yrs. old AND Office Visit with valid E & M Code AND are receiving ESA from you or any provider

Numerator = Quality Measures button in the Superbill- Check box for #123 OR

Lab Result for Hemoglobin entered in Falcon (Interface or Manually entered) > 12OR G0908: Most Recent Hemoglobin (Hgb) level > 12.0 g/dL

AND Use CPT 4171F: Patient receiving erythropoiesis-stimulating agents (ESA) therapy

#128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-UpPercentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented within the past six months or during the current visitBMI Parameters:Age 65 years and older BMI ≥ 23 and < 30Age 18 – 64 years BMI ≥ 18.5 and < 25

Denominator = patients > 18 Yrs old AND Office Visit with valid E & M CodeNumerator = BMI calculated in range OR if BMI is out of range (document Plan of Care

as required) – Quality Measures button in the Superbill- Check box for #128 OR if patient has V65.3 (Dietary Surveillance and counseling) in their problem list OR

G8417: Calculated BMI above normal parameters and a follow-up plan was documented OR

G8418: Calculated BMI below normal parameters and a follow-up plan was documented


Measure #130 (NQF 0419):Documentation of Current Medications in the Medical Record

DESCRIPTION:

Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration.

DENOMINATOR:

All visits for patients aged 18 years and older who had a visit during the reporting period

AND

NUMERATOR:

Eligible professional attests to documenting, updating or reviewing a patient’s current medications using all immediate resources available on the date of encounter. This list must include ALL prescriptions, over-the counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosages, frequency and route of administration.

Select the quality measures button in the superbill – Measures #130

OR

Select the 3rd check box in the Medications/Allergies section in your encounter.

OR

G8427: Current medications documented

Current Medication Documented in Medical Record - #130 (Individual)

#226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening andPercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco userCessation Counseling Intervention – Includes brief counseling (3 minutes or less), and/or pharmacotherapy

Denominator = Patients > 18 Yrs old AND Office Visit with valid E & M CodeNumerator = Enter ANY Smoking Status history in the encounter AND

Checkbox in Assessment & Plan section of the encounter to indicate smoking cessation was discussed OR screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user 4004F: Patient screened for tobacco use AND received tobacco cessation intervention, if identified as a tobacco user OR Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco 1036F: Current tobacco non-userOR Select the checkbox under Quality Measures in the Superbill select – Checkbox # 226


Measures in Review – 226 (Individual)

Measure #236 (NQF 0018): Controlling High Blood Pressure

DESCRIPTION:

Percentage of patients 18 through 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (< 140/90 mmHg) during the measurement period

DENOMINATOR:

Patients 18 through 85 years of age who had a diagnosis of essential hypertension 401.0, 401.1, 401.9 within the first six months of the measurement period or any time prior to the measurement period

NUMERATOR:

Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period

**If you enter the BP in the encounter and put the diagnosis code on the problem list, Falcon will detect this measure automatically.**

OR

Measure #236 (NQF 0018): Controlling High Blood Pressure

G8752: Most recent systolic blood pressure < 140 mmHg OR G8753: Most recent systolic blood pressure ≥ 140 mmHg

AND

G8754: Most recent diastolic blood pressure < 90 mmHg OR G8755: Most recent diastolic blood pressure ≥ 90 mmHg

OR

Patient not Eligible for Recommended Blood Pressure Parameters for Documented Reasons

G9231: Documentation of end stage renal disease (ESRD), dialysis, renal transplant or pregnancy.

OR

Blood Pressure Measurement not Documented, Reason not Given

G8756: No documentation of blood pressure measurement, reason not given

OR Check the box on the Superbill- Checkbox # 236

Measure #236 (NQF 0018): Controlling High Blood Pressure Continued

Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

DESCRIPTION:

Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated

DENOMINATOR:

Percentage of patients aged 18 years and older who have an encounter in the reporting period.

AND

NUMERATOR:

Patients who had BP recorded in Falcon AND have a recommended follow-up plan documented, as indicated if the blood pressure is pre-hypertensive or hypertensive

• Check the box under quality measures in the superbill – Checkbox #317

OR G8783: Normal blood pressure reading documented, follow-up not required

OR G8783: Normal blood pressure reading documented, follow-up not required

OR G8950: Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented

OR G8784: Blood pressure reading not documented, documentation the patient is not eligible

OR G8951: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible OR G8785: Blood pressure reading not documented, reason not given

OR G8952: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

CKD Group Measures

CKD Group Measures – on the Superbill

Criteria for CKD Group Measures

Whether you are reporting for the 1-year period or the 6-Month period you will report on a minimum of 20 unique sample patients - of which only 11 have to Medicare part B. (20 patients in the denominator of each measure will be the same patients). All applicable measures within the group must be reported at least once for each patient within the sample population seen by the eligible professional during the reporting period (January 1 through December 31, 2014 OR July 1 through December 31, 2014) for each of the 20 unique patients

Denominator for ALL measures = patients with CKD stage 4, or 5 AND office visit in the reporting period AND > 18 yrs oldCHRONIC KIDNEY DISEASE (CKD) MEASURES GROUP:#110. Preventive Care and Screening: Influenza Immunization#121. Adult Kidney Disease: Laboratory Testing (Lipid Profile)#122. Adult Kidney Disease: Blood Pressure Management#123. Adult Kidney Disease: Patients On Erythropoiesis-Stimulating Agents (ESA) - Hemoglobin Level > 12.0 g/dL (*)

Summary- What to do in Falcon to

meet PQRS

What do I need to do for Falcon to capture the measures?

• Marking Medicare Part B patients in demographics – THIS IS CRUCIAL. • Click on checkboxes in SUPERBILL that are applicable to patient• Pertinent Labs test results can be entered into Falcon as structured data either through an interface or manually entered into Results Inquiry in order to meet some of the measures. • Entering Diabetes ICD code and CKD ICD codes on the problem list (when applicable)• Entering vitals – some measures need BP and BMI•Document Plan of Care when required.

• If not using Superbill, you must put the appropriate CPT codes for the measures IN THE ENCOUNTER in the procedures section so they are captured for reporting.

Falcon Superbill

Check ALL that are applicable to visit

Measures – on the Superbill

PQRS check boxes indicated on the Superbill will not:

•Print on the claim/Superbill•Flow over to an interfaced billing system on the claim

•**Procedure codes entered will flow to the Superbill

Indicate Medicare Part B patients

Indicate which patients are Medicare Part B in Patient Manager > Demographics with the checkbox

Lab Test Results

LAB TEST RESULTS Entered into Falcon:

Patient Manager > Results Inquiry =

Lab Flowsheet in Encounter =

LAB TEST RESULTS IN ENCOUNTER DO NOT COUNT

Manual Lab entry into Falcon

Patient Manager > Results Inquiry

Click on button to manually add lab test results that did not come through and interface

Measures that need lab results: #1 Diabetes : Hgb A1c Poor Control#2 Diabetes : LDL-C Control

Manual Lab entry into Falcon

Enter lab results for each test into structured fields.

PQRS Measures

Not using the Falcon Superbill?If you are not finalizing superbills for each office visit, the appropriate procedure code (CPT) can be entered into the Procedures section of an encounter.

Tracking Your PQRS

Reporting Period Setup

Main Menu->Quality Scorecard->Reporting Period Setup->Add Reporting Period

How Can I Track my Progress ?

Main Menu->Quality Reporting->Quality Scorecard

There is no performance Goal for PQRS

Use the Medicare Part B report to ensure you have at least one Medicare Part B patient in any Measure you might report on.

NEED NEW SCREENSHOT R36

Medicare Part B Report

How do I report PQRS for 2014

Falcon makes it easy!

Falcon is Certified Registry to report PQRS measures to CMS

Falcon lists the measures on the superbill in easy to use checkboxes

Review your Medicare Part B patients by Drilling down on the measure name on the quality score card

You may run the Medicare Part B report in Falcon under Reports.

Falcon will pull and submit data at the beginning of 2015 via the registry methodPlease return you 2014 PQRS consent forms later this year. Please look for future communication.

© 2013 Falcon, LLC. All rights reserved. Proprietary and confidential.

MOCP and Feedback Reports

Maintenance of Certification Program In 2014, EPs have the opportunity to earn the PQRS incentive and an additional incentive of 0.5% by working with a Maintenance of Certification entity. Here is what is required: Satisfactorily submitting data, without regard to method, on quality measures under PQRS, for a 12-month reporting period either as an individual physician or as a member of a selected group practice AND More frequently than is required to qualify for or maintain board certification: Participate in a Maintenance of Certification Program and Successfully complete a qualified Maintenance of Certification Program practice assessment.

Feedback Reports EPs who report PQRS quality measures data can request to receive National Provider Identifier (NPI)-level Physician Quality Reporting Feedback Reports. The reports include information on reporting rates, clinical performance, and incentives earned by participating individual professionals, with summary information on reporting success and incentives earned at the practice level. The feedback reports can be accessed through the Web portal in the fall of the year following the reporting (e.g. 2013 feedback reports will be available in the fall of 2014).

PQRS NQF Description Domain CQM?

1 0059 Diabetes – Hemoglobin A1c Poor control Clinical Process/Effectiveness Yes

2 0064 Diabetes – LDL-C Control Clinical Process/Effectiveness Yes

110 0041 Flu vaccine Population/Public Health No

121 1668 Adult Kidney Disease – Lipid profile Effective Clinical Care No

122 N/A Adult Kidney Disease – BP Management Effective Clinical Care No

123 1666 Adult Kidney Disease –Hemoglobin Effective Clinical Care No

128 0421 BMI Screening/Followup Population/Public Health Yes

226 0028 Tobacco Use Screening/Cessation Intervention

Population/Public Health Yes

236 0018 Hyptertension: BP Management Clinical Process/Effectiveness Yes

111 0043 Pneumonia vaccine 65+ Clinical Process/Effectiveness No

130 0419 Documentation of meds Patient safety Yes

317 TBD High BP Screening Clinical Process/Effectiveness Yes

PQRS / NQF / CQM Alignment

16

CKD Measures Group

PQRS Requirements

4

2013 PY 2014 PY

• Incentive– Meet 3 individual

measures or the CKD group

• Avoid penalty– Submit 1 valid measure

• Incentive– Meet 9 individual measures

(across 3 domains) or the CKD group

• Avoid penalty– Submit 3 valid measures

• Report 1-2 individual measures across at least 1 NQS domain via qualified registry for 50% or more of applicable Medicare Part B FFS patients and successfully pass the MAV process

© 2013 Falcon, LLC. All rights reserved. Proprietary and confidential.

MAV Process- Avoid Payment Adjustment

Questions?

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How to use Falcon Physician to meet the measures | August 2014