Eli's Rehab Report

If you're a PT or OT in a private practice or physician-owned setting, do you want a shot at some extra cash next year? Gather these critical basics for a head start to a 1.5 percent bonus you can earn for screening patients for future falls risk through the Physician Quality Reporting Initiative, PQRI.

Q: Whom should I screen? Screen patients who are 65 years of age and older -- and to ensure your bonus, screen as many patients as possible who fall into this category. "Providers must report on a quality measure 80 percent of the time it's applicable to receive the 1.5 percent bonus," said Gayle Lee, JD, director of regulatory affairs for APTA, at the course titled "Transforming Physical Therapy: Patient Assessment, Outcome, Measurement and Payment Policy," during the organization's annual conference in Denver.

Q: How does CMS want me to screen for future falls risk? "CMS has not specified a specific way to screen," Christina Metzler, chief public affairs officer for AOTA, tells TCI. But "for 2007, patients aged 65 and older are considered at risk for future falls if they have had two or more falls in the past year or any fall with injury in the past year." So each year, you should ask your patients 65 and older: "Have you fallen before? How many times in the past year? Have any falls resulted in injury?" Metzler says, based on AOTA's recommendations.

Q: How do I prove to CMS that I have screened for future falls risk? Report the appropriate CPT Category II code on the same claim form (paper-based CMS 1500 or electronic 837-P) as your regular PT or OT evaluation/re-evaluation codes (97001-97004). Upon a regular PT/OT evaluation or re-evaluation, "if you screen the patient for future falls risk, and you discover that the patient has had two or more falls in the past year or any fall with injury in the past year, report Category II code 1100F on the claim form," said Ken Harwood, PT, PhD, CIE, APTA director of practice, at the same outcome measurement course at the APTA annual conference in Denver. If you screen the patient and document no falls in the past year or only one fall without injury in the past year, report Category II code 1101F on the claim form, Harwood said.

Tip: If you do not perform the measure for medical reasons (e.g., the patient is not ambulatory), append modifier 1P to 1100F or 1101F. If you do not perform the measure for a non-medical reason (e.g., a language barrier), append modifier 8P to 1100F, Harwood said.

Q: When should I begin reporting this quality measure? You can begin reporting your screens starting July 1. You can report this measure until Dec. 31, 2007, and if you reach the 80 percent reporting requirement, you can expect your 1.5 percent bonus as a lump sum for all of your practice's reported claims in mid-2008, Lee said.

Q: Why are only PTs and OTs in private-practice settings eligible for the bonus? As of now, CMS is using the National Provider Identifier (NPI) as a tracking device -- and there is no place on the UB-04 or 837I claim form to put an NPI, Lee said. So if you're in private practice and your therapists don't have NPIs, now's the time to get them because you have a shot at the bonus.

Even if you are not eligible for a bonus by Dec. 31, experts recommend you begin establishing a screening program for future falls risk regardless. First, CMS is hoping to extend the incentive program into 2008 -- so even if you don't think you can meet the 80 percent threshold in 2007, why not start putting procedures into place so you are eligible in 2008? Harwood said. In addition, APTA is working closely with CMS to figure out a solution for providers in settings that use the UB-04 or 837I claim form so they can participate, Lee said.

Don't miss: Finally, private payers are watching CMS very closely, Lee said -- giving you even more reason to tune in to pay-for-performance initiatives.

Note: Stay tuned for the next issue of Physical Medicine & Rehab Coding Alert for more questions and answers on screening for future falls risk. For more information on PQRI, see www.cms.hhs.gov/PQRI/30_EducationalResources.asp.