Did you know…
- About 23% of quality measures submitted for abstraction have not closed the quality gap because the measure and/or screening information was not found in medical record
- Evidence for member exclusion has only been submitted for three measures; Breast Cancer Screenings, Adult BMI Assessment, and Colonoscopy Screenings
- About 8% of quality measures submitted for abstraction have not closed the quality gap because information from provider only contained evidence of referral (which does not actually close the gap)
- The measures with the most clinical records missing the date of service are: HbA1c Testing, Breast Cancer Screenings, and Colonoscopy Screenings
Quality Measure Refreshers
- Breast Cancer
- Age: Women 52–74 years as of December 31 of the measurement year.
- Requirements for compliance: One or more mammograms any time on or between October 1st two years prior to the measurement year through December 31st of the measurement year (27 month period).
- Exclusions: Exclusions include bilateral mastectomy or two unilateral mastectomies any time during the member’s history through December 31 of the measurement year.
- The Breast cancer screening measures tool will provide additional information on this measure.
- Diabetes Care- Eye Exam
- Age: Members age 18–75 with diabetes (type 1 or type 2).
- Requirements for compliance: A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or a negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year.
- The Diabetic measures toolbook will provide additional information on this measure.
Documentation & Submission Errors
Did you know…
- About 11% of conditions submitted with the PAF/HQPAF cannot be submitted to CMS
- The 3 most common submission errors are:
- D14 – Documentation does not meet CMS standards 79%
- D09 – Provider credentials missing from documentation 5%
- D27 – EMR signature verbiage is invalid for authentication 4%
Documentation Requirements Refresher
- D14 – Documentation does not meet CMS standards
- If a condition is present, check “Assessed” in the Ongoing Assessment & Evaluation Section
- Ensure each present chronic condition is documented to the highest level of specificity in the submitted progress note with the date of service range
- D09 – Provider credentials missing from documentation
- All dates of service must be signed with credentials and dated by the physician (provider) or an appropriate extender (non-physician practitioner) e.g., nurse practitioner
- Ensure all medical records include the provider’s signature and credentials on each encounter. Next to the provider’s signature or pre-printed with the provider’s name on the group practice’s stationery
- Ensure credentials are specific (e.g., do not only include Dr.). This list includes examples of acceptable providers / credentials authorized to sign medical records (this is not an all-inclusive list):
- Medical Doctor (MD)
- Doctor of Osteopathic Medicine (DO)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Bachelor of Medicine, Bachelor of Surgery (MBBS)
- Doctor of Dental Medicine (DMD)
- Doctor of Optometry (OD)
- Credentials from a signature stamp must be accompanied by a written signature per CMS.
- D27 – EMR signature verbiage is invalid for authentication
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.–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 October 1st 2016, we will no longer offer SFTP as an option to submit your Healthcare Quality Patient Assessment Forms/ Patient Assessment Forms (HQPAF/PAF). The last day to use the SFTP for submission will be September 30th, 2016.
Effective immediately, we encourage you to use our new HQPAF/PAF Uploader; an easier and faster submission method. The HQPAF/PAF Uploader requires less time and effort than preparing and submitting documentation via mail or fax.
The HQPAF/PAF Uploader was developed to provide an interface that allows multiple users to securely submit HQPAFs/PAFs without issue of failed delivery or suspended access. The HQPAF/PAF Uploader:
- does not require any user credentials
- complies with all HIPAA guidelines to protect your practice and your patient’s personal data
- allows anyone in your office to access the site and upload documentation
- securely transmits directly to Optum
To get started, please visit: optumupload.com
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.
Did you know…
Your Optum Healthcare Advocate or the Provider Support Center can provide access to a number of tools to assist you in tracking your participation in the program. Please contact your Healthcare Advocate or Optum’s Provider Support Center at 877-751-9207 or via email at providersupport@optum.com with any questions.
To minimize errors, or to correct previously rejected forms, please refer to the HQPAF Checklist and FAQ for Providers.
Remember…
PAF/HQPAF must be submitted via:
- Traceable carrier (any commercial carrier with traceable delivery) to the following address:
- PAF Uploader (Replaces SFTP)
- Secure Fax: 1-877-889-5747
