MACRA Monday: Advance care plan


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:

Limelight Video

Measure #47: Care Plan

This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.

What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.

Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

CMS has a full list of measures available for claims-based reporting at 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).

Next Article:

Trump halts ACA cost-sharing reduction subsidy payments
   Comments ()

Recommended for You

News & Commentary

Quizzes from MD-IQ

Research Summaries from ClinicalEdge

Related Articles

  • Feature

    MIPS: It’s time to get started

    Pick Your Pace offers a way to get started with Medicare’s new QPP and ready physicians for meaningful quality improvement, AMA President David O...