measures group Archives | WebPT


PQRS Back Pain Measures Group Clarification

It’s a new year, and you know what that means: a new PQRS reporting period. Many WebPT Members have already started reporting PQRS data—and that’s great. The sooner you begin reporting, the sooner you’ll reach the minimum reporting requirements and thus ensure you avoid the 2% penalty.

As you might recall from this blog post, you have a few different options when it comes to satisfactory PQRS reporting. For those practitioners who treat a large population of Medicare patients with back pain, we recommended reporting on the back pain measures group, as it is by far the easiest way to not only avoid the penalty, but also earn the 0.5% incentive payment that is available to those who report to the highest possible degree.

Initial Visit vs. Episode
However, the wording Medicare used to explain the requirements for the back pain measures group was a bit confusing, and we’ve received several requests for clarification. According to Medicare’s specifications for this measure (Measure #148: Back Pain: Initial Visit), eligible patients must have a qualifying back pain diagnosis and must not have been “seen or treated for back pain by any practitioner during the 4 months prior to the first clinical encounter with a diagnosis of back pain.”

At first glance, that stipulation may appear to exclude patients who initially saw a physician before being referred to physical therapy. Thankfully, that is not the case. Medicare is merely targeting a more chronic pain patient population who has procrastinated—as many do—before seeking medical attention.  In other words, the date of injury or pain onset must be at least four months prior to the patient’s first visit with any medical professional. Although it’s not immediately clear in the above excerpt, you can report on a patient who has already seen another provider—such as a physician or chiropractor—during a particular episode as long as the patient experienced back pain for at least four months prior to seeking any type of medical treatment. Upon seeking treatment for back pain—whether it’s a recurrence of prior pain or an onset of new pain—the first visit to any medical professional triggers the start of a new episode. But if the patient sees both a primary care physician and a specialist (e.g., a PT), both visits are considered the initial visit for each clinician, and both clinicians can report on the back pain measures group for that patient, even though they are treating within the same episode. In fact, further down in the measure specification document, Medicare provides this direction: “If a patient has a four-month period without treatment, and then sees both a primary care physician and a specialist, both visits are considered the initial visit with that clinician.”

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The Five Things You Need to Know Now About PQRS 2014

Last Wednesday, just before we all headed home to gorge ourselves on turkey and pumpkin pie, Medicare released the Final Rule—all 1,369 pages of it. While it wasn’t exactly light reading, our fearless leader (and speed reader) Heidi Jannenga pored over this hefty document with a mission of finding all the Physician Quality Reporting System (PQRS) information that’s most important to you right now. Below is a breakdown of what you need to know about PQRS 2014.

1.) There are a lot of measures.
We’re talking gobs of measures. Open the Final Rule, head to page 832, and start scrolling. Here are the ones that apply to rehab therapists (and that WebPT currently has or will have in the application):


  • #126 Diabetes Foot/Ankle Evaluation (Registry only)
  • #127 Diabetes – Footwear Evaluation (Registry only)
  • #128 BMI screening
  • #130 Current Medications
  • #131 Pain Assessment
  • #154 Falls Risk Assessment
  • #155 Falls POC
  • #182 Functional Outcome Assessment
  • #245 Chronic Wound Care
  • Back Pain Measure Group (See the next section)


  • #128 BMI screening
  • #130 Current Medications
  • #131 Pain Assessment
  • #154 Falls Risk Assessment
  • #155 Falls POC
  • #134 Preventative Screening Clinical Depression
  • #173 Alcohol consumption Assessment (Registry only)
  • #181 Elderly Maltreatment Screen and Follow-Up
  • #182 Functional Outcome Assessment
  • #226 Tobacco Use Screen and Cessation Intervention


  • #130 Current Medications

Outside of WebPT, there are also FOTO’s Functional Deficit Measures:

  • #217 Change in Risk-Adjusted Functional Status for Patients with Knee Impairments
  • #218 Change in Risk-Adjusted Functional Status for Patients with Hip Impairments
  • #219 Change in Risk-Adjusted Functional Status for Patients with Lower Leg, Foot or Ankle Impairments
  • #220 Change in Risk-Adjusted Functional Status for Patients with Lumbar Spine Impairments
  • #221 Change in Risk-Adjusted Functional Status for Patients with Shoulder Impairments
  • #222 Change in Risk-Adjusted Functional Status for Patients with Elbow, Wrist or Hand Impairments
  • #223 Change in Risk-Adjusted Functional Status for Patients with Neck, Cranium, Mandible, Thoracic Spine, Ribs or Other General Orthopedic Impairments
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Founder Letter: PQRS 2014

Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- and registry-based reporting) and start our month-long blog and webinar theme of “everything you need to know to be PQRS compliant.”

Unfortunately, this year is shaping up a little differently. As a result of the government shutdown, CMS delayed its November 1 meeting to discuss the 2014 Physician Fee Schedule Proposed Rule—which includes potential PQRS changes—until at least the middle of this month. And until they meet, we won’t know much about what PQRS 2014 will truly entail in terms of reporting requirements, measures, penalties, and incentives—let alone when the government will actually finalize the Proposed Rule. This means that as of today, no one knows for sure:

  • which measures therapists must report
  • how many measures therapists must report
  • whether there will be compliance incentives
  • what penalties will be associated with noncompliance
  • what percentage of patients for whom therapists must complete PQRS reporting

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What PQRS Could Look Like in 2014

What PQRS Could Look Like in 2014On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) in the Federal Register. According to this summary, most of the policies were open for comment until September 6, 2013 and, pending final decisions (which hopefully will occur this month), will take effect on January 1, 2014.

The 605-page document contains proposals for policy changes on everything from reimbursements to the Physician Compare tool on the Medicare website, but today, let’s focus on what the rule proposes for the 2014 Physician Quality Reporting System (PQRS). Here are some of the highlights:

  • Eligible practitioners who do not satisfactorily complete PQRS in 2014 may receive a 2% payment adjustment (penalty) in 2016 for services they provide under the Medicare physician fee schedule.
  • Eligible practitioners who do satisfactorily complete PQRS in 2014 may earn a 0.5% bonus (note: 2014 would be the last year to earn an incentive.)
  • CMS may require practitioners to report measures from a certain number of the six categories of the National Quality Strategy (NQS) domains:
    • Person and Caregiver-Centered Experience Outcomes
    • Patient Safety
    • Communication and Care Coordination
    • Community/Population Health
    • Efficiency and Cost Reduction
    • Effective Clinical Care

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PQRS 2013: Outcome Measures

Today’s blog post comes from Senior Copywriters Erica Cohen and Char Bohnett.

CMS‘Tis the season for PQRS. Why the hullabaloo? Because beginning in 2013, not complying with PQRS requirements will result in penalties, which CMS will assess as fines (starting at 1.5% of your fee schedule) in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during the reporting period. With the impendency and necessity of PQRS reporting, we’ve dedicated this month to blog posts on all things PQRS.

Recently, CMS released new information about the PQRS 2013 outcome measures. Compliance guru Tom Ambury will be contributing a blog post with more details in the coming weeks but for now, here’s a brief rundown:

According to the APTA, these are the top 5 measures PTs and OTs used in 2010:

  1. 131 Pain Assessment Prior to Initiation of Patient Treatment*
  2. 154 Falls: Risk Assessment*
  3. 130 Documentation and Verification of Current Medications in the Medical Record*
  4. 155 Falls: Plan of Care*
  5. 128 Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up*

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PQRS: The Case for Registry over Claims Based Reporting

Here at WebPT HQ, we are gearing up for PQRS 2012. One of the pieces of PQRS that is most commonly misunderstood is the difference between claims and registry based services. Let’s take a minute and clear this up.

Claims and registry-based reporting both result in the same outcome for your clinic– successful participation in PQRS. WebPT offers both options with claims-based being priced $99 per calendar year and registry-based at $299 for the calendar year. Many people look at the price and automatically assume claims is the way to go. Not so fast. There are some major cost and workflow considerations when taking on the claims-based beast.

A PQRS claims form has to be filled out in accordance with each note completed. These forms are usually at least a page long and have to be managed and periodically submitted over the course of the year according to dates specified by CMS. In our experience, clinics need to have a dedicated staff member to manage the process or they need to pay a billing service provider to manage the process for them. Both of those options cost significantly more money than the attractive $99 fee for claims. All of the sudden, your clinic has spent a lot more time and money on PQRS than you previously anticipated.

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