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MACRA Monday: Elder maltreatment screening


 

If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #181: Elder Maltreatment Screen and Follow-Up Plan

This measure aims to capture the percentage of patients aged 65 years and older who have a documented elder maltreatment screening and a follow-up plan, if appropriate.

What you need to do: Screen your elderly patients for maltreatment using an Elder Maltreatment Screening tool during the visit and if they screen positive, develop and document a follow-up plan at the visit.

Eligible cases include patients who were aged 65 years or older on the date of the encounter and a have patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96116, 96118, 96150, 96151, 96152, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0270, G0402, G0438, G0439 without telehealth modifiers GQ or GT.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, G8733 indicates that an elder maltreatment screen was documented as positive and a follow-up plan was documented, while G8734 indicates that the screen was negative and a follow-up plan is not required. Use exception code G8535 if the screening was not documented because the patient is not eligible. For example, a patient is not eligible if they require urgent medical care during the visit and the screening would delay treatment.

CMS has a full list measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

  • Those who enrolled in Medicare for the first time during a performance period.
  • Those who have Medicare Part B allowed charges of $30,000 or less.
  • Those who have 100 or fewer Medicare Part B patients.
  • Those who are significantly participating in an Advanced Alternative Payment Model (APM).
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