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Thank you for your participation

Thank you for your participation in the 2016 Patient Assessment Form/Healthcare Quality Patient Assessment Form (PAF/HQPAF) program. As you are prospectively working the program, it is important to ensure that PAFs/HQPAFs are returned in a timely manner with all appropriate accompanying documentation. Timeliness of PAF/HQPAF returns will allow for prompt feedback on remaining risk suspects and care opportunities, so they can be addressed at the next patient encounter.
Please remember:

  • 2016 PAFs/HQPAFs must be returned within 60 days of the DOS with a 2016 calendar year face-to-face encounter.
  • All 2016 PAFs/HQPAFs must be returned by 03/01/2017.
  • All PAFs become ineligible for reimbursement 60 days following the end of the calendar year (2016 PAFs/HQPAFs will not be eligible for any reimbursement once forms expire on 03/01/2017).

Return rate trends

In 2016, Optum® deployed PAFs/HQPAFs for over 1.3 million patients to provider groups nationwide. Provider responsiveness and engagement is at an all-time high with a 27 percent return rate projected through the end of July.

The 2016 HQPAF program marked the beginning of the Rapid Reimbursement rule that ties the timelines of returns to provider reimbursement. PAFs/HQPAFs returned within 60 days of the date of service reimburse at the standard reimbursement rate, while delayed submissions reimburse at a reduced rate. Providers submitting HQPAFs have adopted the change; through mid-July, 92 percent of HQPAF reimbursement payments qualified for the timely reimbursement rate.

This strong and timely return trend has improved the ability of Optum to process submissions in a timely manner and employ vital clinical data in partnership with providers to track and enhance health care quality.

Documentation and coding trainings

In an effort to assist provider groups with proper documentation and coding of chronic conditions, Optum offers monthly online WebEx sessions. Don’t forget to sign up for one of the trainings before the end of the year. Our sessions offer a wide array of topics related to risk adjustment, accurate documentation and coding of several chronic conditions including chronic kidney disease (CKD), peripheral vascular disease (PVD) and diabetes management. Click here to access our training calendar. If you have any questions about a topic or need some additional training on topics previously presented, please reach out to your Optum Healthcare Advocate. Sign up for one of the WebEx sessions now!

Quality measure refresher
  • Colorectal cancer:
    • Age: Members 51–75 years as of December 31 of the measurement year.
    • Requirements for compliance:
      • Fecal occult blood test during the measurement year. iFOBT (immunological fecal occult blood test) or gFOBT (guaiac fecal occult blood test) are acceptable.
      • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year.
      • Colonoscopy during the measurement year or the nine years prior to the measurement year.
    • Exclusions: Members with colorectal cancer or total colectomy.
    • The colorectal cancer screening measures tool will provide additional information on this measure.
  • Did you know...
    • About 38% of medical records submitted to close this measure do not contain or have missing proof of service.
    • About 23% of medical records submitted to close this gap only include proof or referral and do not contain proof of completed screening.
    • About 6% of medical records submitted to close this gap contain a date of service that is out of range with compliance.

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 October 1, 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 30, 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.

To get started, please visit: optumupload.com.