Failure to submit Medicare MIPS quality measures will cost physicians tens of thousands of dollars. For 2018, podiatrists need to submit qualify measures all year and not for just a 3-month window, like in 2017. Also, the penalty for not submitting increases to 5% of Medicare payments.
However, performing MIPS measures may also allow billing for office visits and will increase awareness of when balance AFOs, payable by Medicare, could be prescribed.
MIPS quality measures 154, falls risk assessment and 155, falls, plan of care, address falls being the leading cause of injuries for older adults. One in four Americans aged 65 and over falls each year. By identifying people with gait instability, podiatrists can reduce this risk and make fall prevention a valuable part of their practice.
Annually, Physicians should ask every patient 65 and over whether they have fallen in the past year. If so, they should follow-up by asking how many times, and if the patient suffered an injury. Five to ten percent of all elderly patients will have fallen two or more times, or once with injury–and they are defined to be at high risk.
These patients should be evaluated using a fall risk assessment form, based on the CDC STEADI guidelines, available from SafeStep: MIPS Fall Risk Assessment and Checklist 2018 (73 downloads)
Gait, strength and balance are assessed by having patients perform a “Timed Up and Go Test”. Patients stand, walk 10 feet, turn around and sit down. If TUG takes more than 12 seconds, there’s a good chance such conditions as: muscle weakness, difficulty walking or unsteadiness on feet are present.
MIPS 154 also requires assessing another contributing factor to falling including:
- a review of medications, or
- asking if the patient has had an eye exam in the past year, or
- reviewing other possibly contributing medical conditions, or
- determining the presence of postural hypotension.
Patients should be provided with a Plan_of_Care.pdf that includes balance, strength and gait training instructions, advice about vitamin D and information about home fall hazards.
When patients have NOT fallen two or more times or once with injury, submit MIPS quality measure 154 using CPT code 1101F.
If patients at high risk for falls are evaluated and provided a plan of care, consider billing E&M code 99213. Also submit codes 3288F and 1100F for MIPS 154 and 0518F for MIPS 155.
When there is fall risk, based on gait assessment, consider prescriptions for balance footwear, foot orthotics and possibly balance AFOs.
SafeStep has available, for free, copies of a Fall Risk Assessment form that assists in satisfying the MIPS fall prevention requirements. Medicare compliance documentation for AFOs can be best assured by using SafeStep’s WorryFree DME program.
For additional help and guidance, watch this short video from HealthyOutcomes: MIPS Success with EOS: Billing Codes for Fall Assessment & Plan of Care.
For more information, watch this short video: