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Optum
Healthcare Quality Patient Assessment Form (HQPAF) and Patient Assessment Form (PAF)
2018 HQPAF Program Year Quality Gap Closure
(Data as of August 2018)

Closure of Quality gaps in care is an integral part of the Healthcare Quality Patient Assessment Form (HQPAF) program. Below are the current gap closure rates, by measure. On average, fifty-eight percent (58%) of published Quality gaps have been closed during the 2018 program year. It is important to ensure that HQPAF submissions contain all information necessary to address Quality measures. So far, 65,000 Quality gaps remain open, despite HQPAF submissions, due to missing or illegible information in the medical record.

2018 Quality Gaps Closed by Measure
(Data as of August 13, 2018)

 
Measure Closed Gaps Total Gaps Rate
Adult BMI Assessment 104,603 111,842 93%
Breast Cancer Screening 3,593 23,836 15%
Care of Older Adults Measure
 Pain Screening 6,732 7,422 91%
 Medication Review 6,005 7,406 81%
 Advanced Care Planning 1,853 7,402 25%
 Functional Status Assessment 804 7,274 11%
Colorectal Cancer Screening 24,367 74,573 33%
Comprehensive Diabetes Measure
 Diabetic Nephropathy Screening 23,672 50,697 47%
 Blood Sugar Level (HbA1c) Screening 22,947 50,194 46%
 Diabetic Eye Exam 4,012 48,812 8%
Controlling Blood Pressure 100,965 120,295 84%
Osteoporosis Management 97 649 15%
 


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:
Optum – Prospective Programs Processing
15458 North 28th Avenue, Suite G
Phoenix, AZ 85053
• PAF Uploader: please visit optumupload.com
• Secure Fax:
1‑877‑889‑5747
The CMS Five-Star Quality System Documentation collateral is one of several tools available to assist in closing gaps. For additional assistance on closing Quality gaps, or other tools that may be available, please contact your local Healthcare Advocate or the Optum Provider Support Center at 877-751-9207.

HQPAF/PAF Policy Update: E&O Codes and CGAP Impact

Optum has updated its policies to account for Error & Omissions (E&O) codes that are applied during HQPAF/PAF processing. The codes listed below directly impact the CGAP Documentation Verification metric. If you have any questions, please contact your local Healthcare Advocate.

DOS Level E&O Codes
 
E&O Code Explanation of Code
D02 Encounter is missing the provider’s signature
D09 Encounter is missing the provider’s credentials
D27 EMR Signature verbiage is invalid
 


CGAP Impact: The documentation supplied for the encounter is not compliant with CMS’ documentation guidelines, and the condition cannot be considered verified, resulting in non-compliance with the CGAP documentation verification (using the progress notes) metric.

Remediation: Complete a Secondary Submission. Alternatively, if the client permits documentation verification via claims, the condition may be verified in that manner.

Diagnosis Level E&O Code
 
E&O Code Explanation of Code
D14 Documentation doesn’t meet CMS standards
 


CGAP Impact: Provider stated that the condition has been diagnosed at visit, i.e., selected ‘Yes’, but the condition cannot be coded from the encounter due to (1) the condition is not addressed, or (2) the documentation supplied does meet CMS’ documentation standards. As a result, the condition cannot be verified resulting in non-compliance with the CGAP documentation verification (using the progress note) metric.

Remediation: Complete a Secondary Submission. Alternatively, if the client permits documentation verification via claims, the condition may be verified in that manner.
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.

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.

Optum® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer.

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