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Thank you for participating in the 2015 Patient Assessment Form (PAF) program and the Healthcare Quality Patient Assessment Form (HQPAF) program. If you have not yet received your forms, please contact your Optum Healthcare Advocate.
The HQPAF is a tool designed to assist primary care physicians (PCPs) in the complete and accurate reporting of diagnoses and evaluation of chronic conditions.
- This tool:
- Utilizes diagnosis code data collected from all eligible providers, including inpatient and outpatient hospital and physician visits, as well as pharmacy data
- Combines risk adjustment and quality indicators to support patient assessment
- Incorporates member-specific Star Ratings’* indicators, including medication adherence*
- Highlights suspected chronic conditions for evaluation
- Is not intended to replace the provider’s clinical expertise and judgment or the direct relationship with patients
- The HQPAF program is intended to focus on all patients, but we recommend you prioritize patient visits based on health status severity and acuity.
As we are quickly approaching the CMS announced ICD-10 implementation date of October 1, 2015, which may disrupt regular practice process flows, it is important to schedule remaining annual visits early. Use the PAF/HQPAF to guide the patient visit, assessing any known or suspected conditions and ordering due/overdue labs and screenings to close gaps in care.
Following up with your patients
Consider following up with patients you have referred for health maintenance screenings to ensure they are aware of any upcoming appointments and that they plan to complete the screenings or services that are scheduled.
If you are unable or unwilling to schedule an appointment with the patient, please return the HQPAF with the Patient Status Exceptions section completed, indicating why an assessment could not be performed for that patient.
Submit your completed PAFs/HQPAFs
Please submit your PAFs/HQPAFs, in accordance with any plan-specific submission criteria and any other prior plan-specific communications, as soon as you have them completed — don’t wait until you have several to submit in a batch. The earlier in the year they are returned to Optum, the quicker the turnaround time for your administrative reimbursement. It also allows your Optum Healthcare Advocate ample time to notify you of any issues that may be preventing your form from being considered for payment. Conversely, you may reach out to your Optum Healthcare Advocate at any time to request an updated status of your submitted forms.
We appreciate all that you have done so far this year. Your Optum Healthcare Advocate is a vital resource for helping you correctly complete the PAF/HQPAF program for your office. In addition, your Optum Healthcare Advocate is a valuable resource for providing clinical and coding education, and he or she can provide ICD-9 and ICD-10 coding materials and tools.
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 January 1, 2016, all providers that qualify for HQPAF/PAF administrative reimbursement must receive their reimbursement via direct deposit. In 2016, administrative reimbursement will be completely paperless and checks will no longer be available. To ensure that you do not experience delays in 2016 payments, please visit optum.com/hqpaf or contact Electronic Payments & Statements (EPS) directly at 1-877-620-6194 to enroll.
* The Centers for Medicare & Medicaid Services (CMS) rates the relative quality of the private plans that are offered to Medicare beneficiaries through the Medicare Advantage program. CMS rates Medicare Advantage plans on a one- to five-star scale, with five stars representing the highest quality. The summary score provides an overall measure of a plan’s quality and is a cumulative indicator of the quality of care, access to care, responsiveness and beneficiary satisfaction associated with the plan.
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
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