Embed Size (px)
Citation preview
2019 CMS Web Interface Quality Reporting for MIPS Groups and ACOs
CMS Web Interface Support Call
February 26, 2020
Disclaimer
This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently, so links to the source documents have been provided within the document for your reference.
This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.
2
Announcements
• The following documents are now available on the Quality Payment Program Webinar Library:
- CMS Web Interface Weekly Support Call: Session 5 (Recorded 02/12/2020)
• Recording, Slides, Transcript
3
Announcements
• CMS Web Interface Submission Period (January 2, 2020 - March 31, 2020)
- Submission Period
• The submission period for the CMS Web Interface aligns with other submission types, and closes promptly at 8:00pm Eastern Daylight Time (EDT) on Tuesday, March 31, 2020.
• The CMS Web Interface will automatically accept your submission at the end of the submission period.
• The CMS Web Interface is Accessible via the “Sign In” link on the Quality Payment Program website at https://qpp.cms.gov.
- Submit Your Data Early
• We encourage you to submit your 2019 MIPS performance period data in advance of the submission period deadline. Early submission will provide you with time to receive assistance from the Quality Payment Program Service Center, have Other CMS Approved Reason requests reviewed by CMS, and complete the CMS Web Interface reporting requirements. 4
CMS Web Interface Key Dates
Announcements
5
Upcoming CMS Web Interface Support Calls
• Weekly Support Calls
- Please note: All weekly support calls listed below will be held on Wednesdays from 1:00pm to 2:00pm EST/*EDT.
• For more information on the support calls and links to register, review the 2019 CMS Web Interface Support Calls flyer.
• If you encounter any registration issues or audio issues during a support call, please send an e-mail to [email protected].
March 4, 2020
March 11, 2020*
March 18, 2020*
March 25, 2020*
Reminders
• Other CMS Approved Reason skip requests must be submitted through the CMS Web Interface. - A CMS Approved Reason is a way to skip a patient attributed to a measure during
Denominator Confirmation.
• Reserved for circumstances that are unique, unusual, and not covered by any of the denominator exclusions or denominator exceptions identified in the measure specifications.
• Patients for whom a CMS Approved Reason is selected will be “skipped” and another patient must be reported in their place for the measure, if available.
• When a skip request is denied, the patient will remain incomplete and users must complete reporting on the patient.
• Please review the 2019 measure specifications thoroughly before submitting a CMS Approved Reason request
• Submitting a “2019 CMS Approved Reason” after Friday, March 20, 2020 may cause your request not to be processed prior to the close of submission. Submit such requests as soon as possible.
6
Reminders
• 2019 CMS Web Interface Application Programming Interface (API) is available all year for testing in the Developer Preview Environment:
- For more information, please review:
• CMS Web Interface API Narrative Documents: https://cmsgov.github.io/beneficiary-reporting-api-docs/
• Swagger Documents: https://preview.qpp.cms.gov/api/submissions/web-interface/docs/
• Measures.json: https://preview.qpp.cms.gov/api/submissions/web-interface/metadata
• Schema.json: https://preview.qpp.cms.gov/api/submissions/web-interface/metadata/schema
• Google Group for the CMS Web Interface API: https://groups.google.com/forum/#!forum/cms-web-interface
• From February 1, 2020 to March 31, 2020, the Google Group will be accessible as read-only. Beginning April 1, 2020, this Google Group will no longer be accessible. Please visit qpp.cms.gov for information regarding Quality Payment Program requirements.
• For any support related issues, please contact the Quality Payment Program at [email protected].
7
MEDICAL RECORD DOCUMENTATIONPresenter: Fiona Larbi, CMS
8
Medical Record Documentation
When submitting data through the CMS Web Interface, it is expected for CMS Web Interface reporters to retain supporting medical record documentation demonstrating that the patient met the denominator criteria, the numerator quality action was performed, and/or any applicable denominator exclusions or exceptions existed.
Due to the comprehensive and individual nature of patient medical records only available to CMS Web Interface reporters, CMS cannot provide specific feedback regarding whether or not documentation in a patient medical record (including screenshots) would meet the intent of the measure or be suffice for a given measure in the event of an audit. In the event of an audit, auditors will review measure specifications in comparison to the patient medical record documentation provided by an ACO, MIPS group, or virtual group for each patient sampled for the audit.
9
Medical Record Documentation
10
No. Question Answer
2 Are we allowed to go outside of the ACO participants to find medical record data?
Yes. CMS encourages ACOs to obtain medical records for their assigned and sampled patients. This includes collaborating with physicians and/or other clinic staff both inside and outside the ACO (including but not limited to the NPIs provided in the CMS Web Interface), as well as facilities both inside and outside the ACO, with such collaboration attempts being repeated throughout the course of the data collection period, if needed. Note that the data entered into the CMS Web Interface should never reflect services provided after the end of the performance year (i.e., after 12/31/2019).
Medical Record Documentation
11
No. Question Answer
1 Can a MIPS group add documentation to the EMR in 2020 for PY2019? For instance, if a colonoscopy is not found in the EMR during the data collection period for PY2019 and staff reach out to a performing facility to get a copy and it is scanned in EMR in 2020, can that be counted for PY2019?
The QPP measures should be completed based on information that is available in the medical record prior to the end of the measurement period. There could be instances where the procedure/encounter occurred toward the end of the measurement year and the medical record was updated early in 2020, but these instances should not be the norm. It would be more beneficial to the patient if coordination of care coincided with the patients’ encounters as opposed to collecting missing information afterwards for purposes of quality reporting. The submission period is not intended to be a time for filling in missing information which was only identified due to the patient being attributed to a measure(s) for performance purposes. The measures are not intended to interfere with clinical practices. If a measure calls for information that is not available, then the provider may not meet the intent of the measure.
FREQUENTLY ASKED MEASURE QUESTIONS
Presenter: Angie Stevenson, CMS Contractor
12
MH-1: Depression Remission at Twelve Months
13
No. Question Answer
1 Is an order for an antidepressant medication during the denominator identification period sufficient to confirm a diagnosis of depression?
No. There must be documentation of an active diagnosis of major depression or dysthymia during the denominator identification period (11/1/2017 to 10/31/2018).
Confirmation of the diagnosis of major depression or dysthymia can occur using any of the following methods:• Diagnosis code on the encounter or problem list
(regardless of vendor assigned description of the code)• Words “major depression”, “major depressive disorder”,
“dysthymia”, “dysthymic disorder”, “pervasive depressive disorder” (DSM 5 term for dysthymia) on progress notes or problems lists can be used to confirm the diagnosis.
Additionally, in paper records, the description “depression” may be used with the option to confirm by billing code.
2 Can you please clarify the timing used to identify the following denominator exclusions: active diagnosis of bipolar disorder, personality disorder, schizophrenia, psychotic disorder or pervasive developmental disorder?
A denominator exclusion may be selected if the diagnosis is active anytime prior to the end of the measure assessment period
PREV-7: Preventive Care and Screening: Influenza Immunization
14
No. Question Answer
1 Does a patient refusal have to be documented during the flu season being measured (August 1, 2018 - March 31, 2019)?
You may document patient refusal of the flu vaccine for PREV-7 after March 31st, but the medical record documentation must note that the refusal occurred during the flu season being measured (August 2018 – March 2019 for 2019 reporting).
For 2019, documentation should be during themeasurement period and be specific to the flu seasonbeing reported unless the selection is for documentationof a medical reason for not receiving the influenzavaccination due to an egg allergy. A documented historyof an egg allergy in the patient’s medical record isacceptable for this exception.
PREV-13: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
15
No. Question Answer
1 For population 2, is it acceptable to use any variation of the ICD-10 code E78 to confirm the diagnosis of pure or familial hypercholesterolemia?
The measure requires confirmation of a diagnosis of Familial or Pure Hypercholesterolemia, other cholesterol-related diagnosis are not appropriate. Codes E78.00 and E78.01 are present in the PREV coding document and may be used to identify pure or familial hypercholesterolemia. Other variations of the E78 code are not specific to pure or familial hypercholesterolemia.
If you find other medical record documentation supporting the diagnosis of pure or familial hypercholesterolemia, then the diagnosis may be confirmed.
2 When does the denominator exception (i.e.,allergy or intolerance to statin medication) need to be documented in the medical record?
Medical record documentation should support the denominator exclusion is active during the measurement period.
There are two Numerator Guidance notes that provide instruction regarding how to report an allergy to a statin and the timing requirement for the denominator exception. Please refer to page 14 of the posted measure specification.
RESOURCES & WHERE TO GO FOR HELPPresenter: Fiona Larbi, CMS
16
Resources
• 2019 QPP Resource Library
- Website: https://qpp.cms.gov/about/resource-library
- 2019 MIPS Quality Performance Category
- 2019 CMS Web Interface Fact Sheet
- 2019 CMS Web Interface Measure Specifications and Supporting Documents
- 2019 CMS Web Interface Sampling Methodology
- 2019 CMS Web Interface & CAHPS for MIPS Survey Assignment Methodology
- 2019 CMS Web Interface Excel Template
- 2019 CMS Web Interface Excel Template with Sample Data
- 2019 CMS Web Interface Data Dictionary
- 2019 CMS Web Interface User Guide
- 2019 CMS Web Interface FAQs
- 2019 CMS Web Interface User Demo Videos (Playlist)
• QPP Help and Support
- Website: https://qpp.cms.gov/about/help-and-support
- Materials: Videos, support calls, online courses, learning network, APM learning systems, and developer tools
17
Resources
• 2019 QPP Webinar Library
- Website: https://qpp.cms.gov/about/webinars
- 2019 CMS Web Interface User Demonstration (Recorded 11/13/2019)
• Recording, Slides, Transcript
- CMS Web Interface Kick Off Call (Recorded 12/11/2019)
• Recording, Slides, Transcript
- CMS Web Interface Weekly Support Call: Session 1 (Recorded 1/15/2020)
• Recording, Slides, Transcript
- CMS Web Interface Weekly Support Call: Session 2 (Recorded 01/22/2020)
• Recording, Slides, Transcript
- CMS Web Interface Weekly Support Call: Session 3 (Recorded 01/29/2020)
• Recording, Slides, Transcript
- CMS Web Interface Weekly Support Call: Session 4 (Recorded 02/05/2020)
• Recording, Slides, Transcript
- CMS Web Interface Weekly Support Call: Session 5 (Recorded 02/12/2020)
• Recording, Slides, Transcript
18
Resources
• Medicare Shared Savings Program ACO:
- Website: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html
- Quality Measures & Reporting Standards: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality-Measures-Standards.html
- Weekly ACO Spotlight Newsletter
• Next Generation ACO Model:- Website: https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/
- Connect Site: https://app.innovation.cms.gov/NGACOConnect/
- Weekly Newsletter
19
Medicare Shared Savings Program and Next Generation ACOs
Get Help from CMS
• Quality Payment Program:
- E-mail: [email protected]
- Phone: 1-866-288-8292 (TTY: 1-877-715-6222)
• Medicare Shared Savings Program ACO:
- E-mail: [email protected]
• Next Generation ACO Model:
- E-mail: [email protected]
20
21
Help Us Improve the Quality Payment Program Experience!
We’re looking for participants to collaborate with us and provide feedback regarding the Quality Payment Program website (qpp.cms.gov), including the following:
The QPP Research Teams invite you to participate in our Human-Centered Design efforts.
Interested in participating?Email your name, title, topic of interest, and organization to:
Our research sessions range from 30-60 minutes and you can join by phone or webinar.
• Educational Materials• Website Content • Website Design
• Reporting Design• Eligibility Content Layout• Performance Feedback Layout
Question and Answer Session
To ask a question over the phone line, please raise your hand and we
will unmute your line.
For those dialed in via phone, you must have your unique audio pin entered. If you’re listening through your
computer speakers and want to ask a question, you must have a working microphone.
You may also submit questions via the Questions tab for speakers to read aloud.
Speakers will address as many questions/comments as time allows.
22
Get Help from CMS
• Quality Payment Program:
- E-mail: [email protected]
- Phone: 1-866-288-8292 (TTY: 1-877-715-6222)
• Medicare Shared Savings Program ACO:
- E-mail: [email protected]
• Next Generation ACO Model:
- E-mail: [email protected]
23
