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ICD-10 is here! Even though this is a change in the office workflow, be sure to continue managing your PAFs/HQPAFs . If you haven’t done so, creating a plan for any outstanding PAFs/HQPAFs that need to be completed will help you finish the 2015 program year successfully. Your Healthcare Advocate can assist you in successfully executing a plan that will help you attain a 100% return rate. If you are having any difficulties or challenges, reach out to your Optum Healthcare Advocate today. He or she will be happy to assist you in prioritizing the program so you can complete the needed forms with the greatest number of open care opportunities to be addressed before the end of the year. Please be sure to follow any prior notices you received from Optum about the PAF/HQPAF prioritization guidelines set by our health plan clients.
Ensure all Medicare Advantage members have had at least one visit
Here are some tips to ensure your Medicare Advantage patients are seen by December 31, 2015.
- Utilize Optum reports for prioritizing patients that have not had a visit and are high risk for chronic conditions.
- If possible, query your EMR/EHR by age, health plan or 2015 billing to determine who needs a visit.
- Contact those patients to schedule a visit before December 31, 2015.
Utilizing the PAF/HQPAF at the time of visit
We encourage the provider to review the PAF/HQPAF prior to or during the patient’s office visit to assist in documenting all conditions evaluated, monitored and treated and address screenings/referrals.
- At the time of the visit, the provider should assess any chronic conditions that have not been assessed in the current year and document in the progress note.
- Focus on the HEDIS screenings and document whether a member has completed the screening or was referred for the appropriate services.
- Prior to submitting your HQPAF, review your dates of service on the progress note to ensure that you have one or more visits during the current calendar year.
- Be certain all pages of the progress note along with any consult notes are included and the signature page of the provider is attached.
Your Healthcare Advocate is always available to assist you and address any questions you may have. The goal is to submit 100% of your forms correctly on the first submission and minimize any errors or rejections.
Talk to your local Optum Healthcare Advocate for additional tools on the PAF/HQPAF program. This includes the HQPAF provider instructions and the HQPAF provider brochure.
If you have any questions about the PAF or HQPAF programs, please contact your local Optum Healthcare Advocate or the Optum Provider Support Center between 6:30 a.m. and 4:30 p.m. PST, Monday–Friday, at 1-877-751-9207 or email us here.
Thank you again for your participation in the Optum Patient Assessment Form (PAF) and the Healthcare Quality Patient Assessment Form (HQPAF) programs.
As of January 1, 2016, all providers that qualify for HQPAF/PAF administrative reimbursement must receive their reimbursement via direct deposit. In 2016, administrative reimbursement will be completely paperless and checks will no longer be available. To ensure that you do not experience delays in 2016 payments, please visit optum.com/hqpaf or contact Electronic Payments & Statements (EPS) directly at 1-877-620-6194 to enroll.
For additional information as well as publications and products available for HEDIS®, please visit the National Committee for Quality Assurance (NCQA) website at ncqa.org.
For additional information about the Medicare Advantage Five-Star Quality Rating System, please refer to: http://go.cms.gov/partcanddstarratings
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