New MIPs Measures for 2020

New MIPs Measures for 2020

Kim Cavitt, Au.D.

Merit Based Incentive Payment System (MIPS)

The 2020 Medicare Final Rule maintained the 2019 low volume thresholds ($90,000 in Medicare Part B covered professional services, providing covered care to 200 or more Medicare beneficiaries and providing 200 or more covered Medicare services). As a result, most audiologists will continue to be voluntary MIPS reporters, with the exception of those working within a Medicare Alternative Payment Model (APM; this is uncommon in private audiology practices with no medical practice or hospital affiliation).

Audiology will be eligible to report on nine total quality measures and will continue to be eligible to attest to clinical improvement activities. The quality measures are:

  • Documentation of Current Medications in the Medical Record
  • Preventive Care and Screening: Screening for Depression and Follow-Up Plan
  • Falls: Risk Assessment
  • Falls: Plan of Care
  • Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
  • Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention

These six measures were available in MIPS in 2019 and were also available in the 2016 Physician Quality Reporting System (PQRS).

The three new audiology measures for 2020 are:

  • Elder Maltreatment Screen and Follow-Up Plan
  • Functional Outcome Assessment
  • Falls: Screening for Future Falls Risk

Elder Maltreatment Measure Specifics

  • Report at least once per calendar year for 50% of eligible patients.
  • Requires care plan.
  • Eligible for CPT Codes:
    • 92540, 92541, 92542, 92550, 92557, 92567, 92570, 92587, 92588, and 92625
  • ICD 10 Codes
    • None specified (so all included)

What is Elder Maltreatment?

  • Physical Abuse
  • Psychological Abuse
  • Neglect
    • By a caregiver or family member; not self neglect
      • Active Behavior that is willful or when the caregiver intentionally withholds care or the neglect may be motivated by financial gain or reflect interpersonal conflicts.
      • Passive Situations where the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of
  • Sexual Abuse
  • Elder Abandonment
    • Desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.
  • Financial or Material Exploitation
  • Unwarranted Control
    • Controlling a person’s ability to make choices about living situations, household finances, and medical care.
  • Elder Maltreatment Screening tools, Including but not limited to:
  • Elder Abuse Suspicion Index (EASI)
  • https://www.mcgill.ca/familymed/files/familymed/easi_english_january_2013.pdf
  • Vulnerability to Abuse Screening Scale (VASS)
  • https://medicine.uiowa.edu/familymedicine/sites/medicine.uiowa.edu.familymedicine/files/wysiwyg_uploads/VASS.pdf
  • Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST)
  • https://medicine.uiowa.edu/familymedicine/sites/medicine.uiowa.edu.familymedicine/files/wysiwyg_uploads/HS_EAST.pdf

Elder Maltreatment Care Plan

  • Have a plan if your patient is in immediate, life threatening danger.
  • Call 911.
  • Must include a documented report to state or local Adult Protective Services (APS) or the appropriate state agency.

Resources

  • National Adult Protective Services Association: http://www.napsa-now.org/get-help/help-in-your-area/
  • ElderCare locator:
    • https://www.hhs.gov/answers/programs-for-families-and-children/how-do-i-report-elder-abuse/index.html
    • https://eldercare.acl.gov/Public/Index.aspx
  • National Center on Elder Abuse: https://ncea.acl.gov/

G codes:

  • G8733: Elder maltreatment screen documented as positive AND a follow-up plan is documented.
  • G8734: Elder maltreatment screen documented as negative, follow-up is not required.
  • G8735: Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter.
    • Patient refuses to participate and has reasonable decisional capacity for self-protection.
    • Patient is in an urgent or emergent situation.
  • G8941: Elder maltreatment screen documented as positive, follow- up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter.
  • G8536: No documentation of an elder maltreatment screen, reason not given.
  • G8735: Elder maltreatment screen documented as positive, follow- up plan not documented, reason not given.

Functional Outcome Assessment

  • Report at least once per calendar year for 50% of eligible patients.
  • Requires care plan.
  • CPT Codes:
    • 92540, 92541, 92542, and 92548
  • ICD 10 Codes
    • None specified (so all included)
  • Functional Outcome Assessment Screening tools, including, but are not limited to:
    • Select measure(s) that are appropriate for your patient population.
    • Dizziness Handicap Inventory (DHI)
      • http://www.rehab.msu.edu/_files/_docs/Dizziness_Handicap_Inventory.pdf
    • Berg Functional Balance Scale
      • https://cdn.ymaws.com/www.fpta.org/resource/resmgr/imported/Balance%20Assessements.pdf
    • Activities Specific Balance Confidence Scale (ABC)
      • http://www.pro-pt.net/files/pdf/Outcome%20Measures/ABC_Scale-Final.pdf
    • Patient-Reported Outcomes Measurement Information System (PROMIS)
      • http://www.healthmeasures.net/explore-measurement-systems/promis/obtain-administer-measures
  • G codes:
    • G8539: Functional outcome assessment documented as positive using a standardized tool AND a care plan based, on identified deficiencies on the date of the functional outcome assessment, is documented.
    • G8542: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required.
    • G8942: Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented.
    • G8540: Functional outcome assessment NOT documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
    • G9227: Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter.
      • Patient refuses to participate.
      • Patient unable to complete questionnaire.
      • Patient is in an urgent or emergent medical situation.
    • G8541: Functional outcome assessment using a standardized tool not documented, reason not given.
    • G8543: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given.

Falls Risk: Future Falls Risk

  • This measure is for registry or CMS Web Interface/EHR reporting only. It is not eligible for CMS 1500 claims reporting.

If ADA members have further questions or would like to learn more, please contact Kim Cavitt at This email address is being protected from spambots. You need JavaScript enabled to view it. or 773-960-6625 (text or call). ■

Dr. Kim Cavitt was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.