APMA News - July/August 2017 - 42

IT Consultant
By James R. Christina, DPM

Don't Give Away Your Hard-Earned Dollars in 2019
The statistics are shocking. Despite every effort by APMA to
inform our members of penalties associated with the Physician
Quality Reporting System (PQRS), CMS just released some statistical reports on penalties assessed by specialty. Here is a breakdown for podiatry from the report:
2015-8,913 subject to penalty (48.9 percent)
2016-13,175 subject to penalty (69.7 percent )
2017-11,730 subject to penalty (61.9 percent )

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The PQRS, Meaningful Use of Electronic Health Records
(MU), and Value Based Modifier (VM) programs no longer exist. The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) eliminated the Sustainable Growth Rate and replaced
the previous quality programs with new quality payment programs (QPPs), specifically the Merit-based Incentive Payment
System (MIPS) and Alternative Payment Models (APMs). For
2017, most podiatrists will participate in MIPS. Failure to participate in MIPS this year will result in a 4-percent reduction in all of
your Medicare Part B Fee for Service payments in 2019.
So how do we make sure that the abysmal statistics related
to PQRS are not repeated for MIPS? While APMA recommends
performing more than just the minimum to avoid the penalty
(as there are incentive payments available for performing very
well in MIPS), at least do the following in your office tomorrow to make sure you are protected from the 2019 penalty:
Report one quality measure on one patient

You can report multiple quality measures using the claims
method. If you visit https://qpp.cms.gov, you will find all avail-

able measures you can report by putting a code on a claim after
you perform the measure. One easy way to do this is through
the Tobacco Screening and Cessation Intervention quality measure. Here are the keys:
The patient must be a Medicare Part B Fee for Service
patient (not HMO, Advantage, etc.)
You must be seeing the patient for an Evaluation and
Management Service
You must include the proper quality code on the claim
when it is submitted for the E/M Service
So how do you do it?
If the patient meets the requirements above, ask the
patient about use of any type of tobacco.
Document the answer in the chart.
If the patient does not use any tobacco products, include code 1036F (indicates current tobacco non-user)
on the claim form.
If the patient does use tobacco products, provide brief
counseling on the dangers and explain there are cessation programs available. Document this discussion in
the chart. You do not have to prescribe medication or
supervise a tobacco cessation program. You simply have
to provide brief counseling (fewer than three minutes).
You then include the code 4004F on the claim form.

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Your claim form should look something like the example
at bottom left (for a non-tobacco user).
To be on the safe side, perform this quality measure for several patients to make sure CMS records that you did at least one
quality measure on one patient.
Some eligible providers are
exempt from MIPS in 2017. To
check your status, visit https://
qpp.cms.gov/learn/eligibility.
Remember-you must meet
the MIPS requirements for each
combination of your NPI/TIN
that you use for billing.
APMA has a wealth of resources on the Quality Payment Programs at www.apma.
org/MACRA.
n
Contact Dr. Christina at
jrchristina@apma.org.

42 APMA News July/August 2017

https://qpp.cms.gov http://qpp.cms.gov/learn/eligibility http://qpp.cms.gov/learn/eligibility http://www.apma.org/MACRA http://www.apma.org/MACRA

Table of Contents for the Digital Edition of APMA News - July/August 2017