PQRS Guide for Mental Health
by Leigh-Ann Renz 6.6.13
The Physicians’ Quality Reporting System (PQRS) was a voluntary program for reporting to CMS (Centers for Medicare and Medicaid). Starting in 2013, it’s mandatory, and penalties will now be imposed on non-reporting physicians, including psychologists. If you are enrolled in Medicare under the clinical psychologist designation, have an NPI number, participate in the PECOS program and are reimbursed by Medicare under the Physician Fee Schedule (PFS), you must begin reporting certain quality measures to CMS starting in 2013 or you will start to be penalized in 2015. Click here for an overview of PQRS, including penalty details.
Step by Step Guide
(for psychologists participating in PQRS for the first time in 2013)
1) Determine the reporting method for your practice: there are several methods for reporting PQRS data, but one easy way is via claims-based reporting. You simply add a few codes to the claim that you currently submit to Medicare. This can be through the standard CMS-1500 form, registry-based, qualified EHR (like PIMSY), or a Group Practice Reporting Option (GPRO). See the sidebar links here for details about each reporting method.
2) Pick a measure to report on: see the list of 13 available measures below and find which ones match the services you provide. CMS suggests you report on at least three measures, but as long as you report on at least one measure in 50 percent of the applicable cases you may be eligible for the bonus payment. You can report 1 or 2 measures if less than 3 are applicable to your practice.
3) Find the correct CPT code(s): the CPT (billing) codes for mental health changed effective January 1st, 2013, so be sure to use the correct code for the service provided.
4) Use the appropriate G code: G codes are used to indicate what action, if any, was taken. Because PQRS is a reporting program, not pay-for-performance, providers may report that they did not provide the action specified under the measure and still qualify for bonus payments (or meet the minimum criteria and avoid penalties). Details about G codes can be found in the measure worksheets of the 2013 PQRS Measures Specification Manual.
PQRS Available Measures for Psychologists
- Major depressive disorder: antidepressant medication during acute phase for patients with MDD (#9)
- Major depressive disorder: diagnostic evaluation (#106)
- Major depressive disorder: suicide risk assessment (#107)
- Preventive care and screening: Body mass index screening and follow-up (#128)
- Documentation and verification of current medications in the medical record (#130)
- Pain assessment prior to initiation of patient therapy and follow-up (#131)
- Screening for clinical depression and follow-up plan (#134)
- Preventive care and screening: Unhealthy alcohol use—screening (#173)
- Elder maltreatment screen and follow-up plan (new measure effective in 2009)
- Preventive care and screening: Tobacco use assessment and tobacco cessation intervention (#226)
- Substance use disorders – counseling (#247)
- Substance use disorders – Screening for depression (#248)
- Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (#325)
Q: How quickly can I expect the incentive bonus?
A: All claims have to be filed before CMS calculates the bonus payments. They are paid in the middle of the following year.
Q: How do I enroll?
A: There is no enrollment; as long as you qualify to participate (click here to confirm), you simply start reporting on services.
Q: When should I start reporting?
A: If you’re looking to simply avoid the penalties, you only need to report one service measure for at least 1 applicable client in 2013. If you’re looking to obtain the bonus, you must report on 50% of the applicable cases for a given measure, so obviously those providers should start reporting as soon as possible to meet the 50% threshold by the end of the year.
Q: What if none of those measures apply to my practice? Will I be penalized for that?
Additional Resources / Ask Questions / Sources