TABLE 11: Summary of CY 2017 Chronic Care Management (CCM ...€¦ · TABLE 11: Summary of CY 2017 Chronic Care Management (CCM) Service Elements and Billing Requirements Initiating

TABLE 11: Summary of CY 2017 Chronic Care Management (CCM) Service Elements and Billing Requirements

Initiating Visit- Initiation during an AWV, IPPE, or face-to-face E/M visit (Level 4 or 5 visit not required), for new patients or patients not seen within 1 year prior to the commencement of chronic care management (CCM) services.

Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications and medication allergies using certified EHR technology. A full list of problems, medications and medication allergies in the EHR must inform the care plan, care coordination and ongoing clinical care.

24/7 Access & Continuity of Care

Provide 24/7 access to physicians or other qualified health care professionals or clinical staff including providing patients/caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week.

Continuity of care with a designated member of the care team with whom the beneficiary is able to schedule successive routine appointments.

Comprehensive Care Management- Care management for chronic conditions including systematic assessment of the beneficiary’s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of beneficiary self-management of medications.

Comprehensive Care Plan

Creation, revision and/or monitoring (as per code descriptors) of an electronic patient-centered care plan based on a physical, mental, cognitive, psychosocial, functional and environmental (re)assessment and an inventory of resources and supports; a comprehensive care plan for all health issues.

Must at least electronically capture care plan information, and make this information available timely within and outside the billing practice as appropriate. Share care plan information electronically (can include fax) and timely within and outside the billing practice to individuals involved in the beneficiary’s care.

A copy of the plan of care must be given to the patient and/or caregiver

Management of Care Transitions

Management of care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities.

Create and exchange/transmit continuity of care document(s) timely with other practitioners and providers.

Source: Pages 331, Federal Register/November 15, 2016

(Link provided, but will be moved as of November 16 upon final publication)

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26668.pdf

Provided by Elizabeth Woodcock @ www.elizabethwoodcock.com

Home- and Community-Based Care Coordination

Coordination with home and community based clinical service providers.

Communication to and from home- and community-based providers regarding the patient’s psychosocial needs and functional deficits must be documented in the patient’s medical record.

Enhanced Communication Opportunities- Enhanced opportunities for the beneficiary and any caregiver to communicate with the practitioner regarding the beneficiary’s care through not only telephone access, but also through the use of secure messaging, Internet, or other asynchronous non-face-to-face consultation methods.

Beneficiary Consent

Inform the beneficiary of the availability of CCM services; that only one practitioner can furnish and be paid for these services during a calendar month; and of their right to stop the CCM services at any time (effective at the end of the calendar month).

Document in the beneficiary’s medical record that the required information was explained and whether the beneficiary accepted or declined the services.

Medical Decision-Making- Complex CCM services require and include medical decision-making of moderate to high complexity (by the physician or other billing practitioner).

By Elizabeth W. Woodcock, MBA, FACMPE, CPC

2016©

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Elizabeth W. Woodcock, MBA, FACMPE, CPCSpeaker, Author, Trainerwww.elizabethwoodcock.com MBA, Wharton School of Business, University of Pennsylvania BA, Duke University Fellow, American College of Medical Practice Executives Certified Professional Coder Author, 16 textbooks and more than 500 Articles Founder and Principal, Woodcock & Associates Former Consultant, Medical Group Management Association; Group Practice Services Administrator, University of Virginia Health Services Foundation; Former Senior Associate, Health Care Advisory Board

©2

2016©

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Medicare 2017 ICD10 Meaningful Use Penalties Quality Payment Program

Merit-based Incentive Payment System

Conclusion

2016©

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CMS Final Rule

November 2, 2016

Publication Date: November 15, 2016

http://bit.ly/2fFJ6Hf

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Law

Actual

Exception - 2014Q1 had a 0.5% rate increase

0.50%

(0.26%)

0.24%

2016©

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Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes only. Includes physician specialties only. All other specialties 0% impact.

Review Your Appendix

Allergy/Immunology 1% Ophthalmology -2%Family Medicine 1% Urology -2%General Practice 1% Gastroenterology -1%Geriatrics 1% Interventional Radiology -1% Internal Medicine 1% Neurosurgery -1%

Oral/Maxillofacial Surgery -1%Otolaryngology -1%Pathology -1%Radiology -1%

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Effective for services furnished beginning

January 1, 2017… [Medicare] reduces by

20 percent the payment amounts…for the

technical component (TC) (including the

TC portion of a global service) of imaging

services that are X-rays taken using film.

The modifier FX is required on claims for the technical component of the X-ray service, including when the service is billed globally,

Modifier FX

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G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar

month of behavioral health care manager activities…

G0503: Subsequent psychiatric collaborative care management, first 60 minutes in a

subsequent month of behavioral health care manager activities…

G0504: Initial or subsequent psychiatric collaborative care management, each additional 30

minutes in a calendar month of behavioral health care manager activities…

Behavioral Health

Note: CPT codes are a registered trademark of the

American Medical Association (AMA). Please

review the complete definition in your CPT®

Manual, and any applicable guidance from the

Centers for Medicare & Medicaid Services if billing

a Medicare-only “G” code.

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99490 Chronic Care Management Services

“Services are provided when medical and/or psychosocial

needs of the patient require establishing, implementing,

revising, or monitoring the care plan. Patients who receive

chronic care management services have two or more

chronic conditions or episodic health conditions that are

expected to last at least 12 months, or until the death of

the patient, and place the patient at significant risk of

death, acute exacerbation/decompensation, or functional

decline.”

$40.82Starting with January 1, 2015 Dates of Service

Reimbursement based on current “Georgia - 1020201” reimbursement for Medicare 2016. Locality 1020299 (“Rest of Georgia”) is $38.91. Non-

facility.

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G0506: Comprehensive assessment of and care planning by the

physician or other qualified health care professional for patients requiring

chronic care management services, including assessment during the

provision of a face-to-face service (billed separately from monthly care

management services) (Add-on code, list separately in addition to primary

service).

99490

99487 Complex chronic care w/o pt vsit99489 Complex chronic care addl 30 min

2016©

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Review Your Appendix

99490 – Highlight of Changes

• Creation of structured clinical summary record not

required.

• Separate written patient consent not required; sufficient

to document acceptance of services in medical record.

• 24/7 access equates to contact with health care

professional; access to electronic care plan not required.

• Care plan can be shared with other practitioners via fax.

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CPT code 99358 (Prolonged evaluation and

management service before and/or after direct patient care,

first hour); and

CPT code 99359 (Prolonged evaluation and

management service before and/or after direct patient care,

each additional 30 minutes (List separately in addition to

code for prolonged service).

Non-Face-to-

Face Services

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TelehealthESRD-Related Services

Advanced Care PlanningCritical Care Telehealth Consults

New Place of Service Code 02

Under ScrutinyZero-Day Global Services billed

with Modifier -25

Global Period@270 CPT Codes

Surgeons in Groups of 10+9 States; Not MS

Informal ReviewPQRS/VBPM informal review streamlined for participating

physicians

2016©

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TelehealthESRD-Related ServicesAdvanced Care PlanningCritical Care Telehealth Consults

New Place of Service Code 02


with Modifier -25


Surgeons in Groups of 10+9 States; Not GA


physicians

2016©

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New Place of Service Code


with Modifier -25




physicians

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with Modifier -25

Global Period@270 CPT CodesSurgeons in Groups of 10+9 States; Not GA


physicians

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with Modifier -25




physicians

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Was Over

October 1,

2016

ICD-10

2017 Updates (Oct 1, 2016-Sept 30, 2017) Posted

http://go.cms.gov/28ZiPxA

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…any continuous 90-

day period between

January 1, 2016 and

December 31, 2016.

http://bit.ly/2fcXuUl

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Year eRx PQRS EHR (MU) VBPM+ Total

2012 -1.0% - - - -1.0%

2013 -1.5% - - - -3.5%

2014 -2.0% - - - -4.0%

2015 - -1.5% -1.0% -1.0% -5.5%

2016 - -2.0% -2.0% -2.0% -8.0%

2017 - -2.0% -3.0% -4.0% -9.0%

2018 - -2.0% -3.0% -4.0% -9.0%+Value-Based Payment Modifier phases in the payment adjustments based on the size of the practice, so the penalty may be higher.

Remember… 2018 is being determined by your participation in 2016!!

Penalties for Not Participating (in the

Government’s Programs) are Piling Up

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CO237 = Legislative Penalty

N699 = PQRS

N700 = EHR Incentive Program

N701 = Value-Based Payment Modifier

http://go.cms.gov/2e1Zv5Z

Medicare Remittance

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1. Advanced

Alternative Payment

Model (APM)

Participant

2. Everyone Else

Merit-based Incentive

Payment System

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$30,000 in Total Allowed Part B Charges

1. Allowed charges = Allowable for that particular service

99213 $200.00 $73.40CPT® Your Charge Allowed Charge*

*Reflects the current (2016) National Payment Amount for 99213; non-facility price.

This is only an estimate, but this translates into $60,000 to $90,000 in gross

charges for most medical practices.

Payment

$??

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“…Beneficiaries enrolled in Medicare Advantage plans that receive their Part B

services through their Medicare Advantage plan will not be included in allowed

charges billed under Medicare Part B for determining the low-volume threshold.”

- CMS

2. Part B = Traditional Medicare. It does not include

Medicare Advantage.

$30,000 in Total Allowed Part B Charges

• First Year Medicare Participant^…

• Perform Services for <100 Medicare patients

• Not enrolled in Medicare

^Per CMS, “a professional who first becomes a Medicare-enrolled eligible clinician within the PECOS.”

CMS will perform a quarterly check.

32.5%

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“[We] intend to provide a NPI level lookup feature prior to or shortly after

the start of the performance period that will allow clinicians to determine if they do not exceed the low-volume threshold and are therefore excluded

from MIPS.”-CMS

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October 14, 2016

List of Advanced APMs

Source: CMS. https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

“These APMs are

scheduled to be

implemented in 2017 or

2018 but have design

parameters that have not

yet been finalized. We

will update this list … to

reflect changes as they

are finalized.” 5 to 8%New ACO Track One Model 2018

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2-Year

2019

Deadline

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Option Result

Report all required elements for 90 consecutive days

Bonus

Report >1 quality measure, >1 improvement activity and all ACI measures

“Small” bonus

1 quality measure; 1 improvement activity OR all ACI measures

No payment increase; no penalty

Advanced APM Automatic 5% increase

“Pick Your Pace” 2017

If you do nothing, you will be penalized 4% on all of your Medicare reimbursement.

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Potential for 3x adjustment for

“exceptional performance”

+4%

-4%

+5%

-5%

+7%

-7%

+9%

-9%

Adjusted Medicare Part B Payment to Clinician

[ based on a MIPS Composite Performance Score ]

2019 2020 2021 2022 onward

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1

Quality

2

Cost

3

Advancing Care Information

4

Improvement Activities

Eliminated in 2017

Composite Performance

Score

Advancing Care Information = New Name for “Meaningful Use”

All measures can be viewed at https://qpp.cms.gov/

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Basically Replicates the Current

Programs from a Reporting Perspective

“MACRA requires us to measure performance, not

reporting.” - CMSSource: CMS, Final Rule (10/14/16)

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Performance = Comparison to

measure-specific benchmarks

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QualityMeasure

100 Patients

80 Patients

80% 90%Measure-Specific

https://qpp.cms.gov/

2016©

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• Medicare 2017

• ICD10

• Meaningful Use

• Penalties

• Quality Payment Program

• Merit-based Incentive Payment System

2016©

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Question & Answer Session

2016©

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Exempt from MIPS? Low-Volume Threshold Determination Period

“…Define the low-volume threshold determination period to mean a 24 month assessment period, which includes a two-segment

analysis of claims data during an initial 12-month period prior to the performance period followed by another 12-month period

during the performance period. The initial 12-month segment of the low-volume threshold determination period would span from the

last 4 months of a calendar year 2 years prior to the performance period followed by the first 8 months of the next calendar year

and include a 60-day claims run out, which will allow us to inform eligible clinicians and groups of their low-volume status during the

month (December) prior to the start of the performance period. To conduct an analysis of the claims data regarding Medicare Part B

allowed charges billed prior to the performance period, we are establishing an initial segment of the low-volume threshold

determination period consisting of 12 months.

12 months of data starting from September 1, 2015 to August 31, 2016, with a 60 day claims run out.

Material in this Appendix from the Centers for Medicare &

Medicaid Services (CMS) extracted from October 14, 2016 Final

Rule, noting that it will be published in an upcoming Federal

Register that will have a future date, unless otherwise specified.

https://qpp.cms.gov/docs/CMS-5517-FC.pdf

2016©

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• Physician

• Physician assistant

• Nurse practitioner

• Clinical nurse specialist

• Certified registered nurse anesthetist

Eligible Clinicians

• Can instead report as a group• There will be an “election process.” “…If a group is submitting information

collectively, then it must be measured collectively for all four MIPS performance

categories: quality, cost, improvement activities, and advancing care information.” - CMS

• “Virtual groups” can be formed, but not until 2018

2016©

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Eligible Clinicians

“While we have multiple identifiers for participation and performance, we are finalizing

the use of a single identifier, TIN/NPI, for applying the MIPS payment adjustment,

regardless of how the MIPS eligible clinician is assessed…Each unique TIN/NPI

combination will be considered a different MIPS eligible clinician, and MIPS

performance will be assessed separately for each TIN under which an individual bills.”

“[Others]… may voluntarily report on measures and activities under MIPS, but will not be

subject to the MIPS payment adjustment.”

Payment Adjustments will not be Applied to FQHC or RHC All-Inclusive Rates, so

Participation is not Expected, but it is Voluntary

Source: CMS, Final Rule (10/14/16)TIN = Tax Identification Number

NPI = National Provider Identifier

MIPS = Merit-based Incentive Payment System

FQHC = Federally Qualified Health Center

RHC = Rural Health Clinic

2016©

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Basically Replicates PQRS from a Reporting Perspective

Per CMS, “The CPT codes that have historically been available under the PQRS program will be made available for the MIPS as part of the detailed measure

specifications which will be posted prior to the performance period at QualityPaymentProgram.cms.gov.”

Almost Exactly the Same Measures (271), as well as Reporting Options

CMS Web Interface for Groups

Qualified Clinical Data Registry (QCDR)*

Qualified Registry

Electronic Health Record

Claims

Accountable Care Organization~

*More information: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/qualified-clinical-data-registry-reporting.html

At least 50% of patients that meet

the measure’s denominator criteria,

regardless of the payer

Same, but only Medicare Part B

Sample provided by CMS; 248

Medicare beneficiaries

No separate reporting; via ACO

~“Official” ACO, recognized as able to successfully submit data to CMS (e.g., Medicare Shared Savings)

PQRS = Physician Quality Reporting System

2016©

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Base Score

50 Points

[ Required Measures* ]

*Failure to report any of these five elements successfully results in a “zero” base score, which automatically translates into a “zero” performance

score for this category.

^MIPS-eligible clinicians who write fewer than 100 permissible prescriptions in a performance period may elect to report a null value.

Perform Security Risk Assessment

(Y/N)

ePrescribe^

Send Summary of Care

Request/Accept Summary of Care

Provide Patient Access

In 2017, can

use 2014 or

2015 Edition

CEHRT; must

be 2015

Edition

certified in

2018.

This table reflects the 2015 Edition of CEHRT (Certified EHR Technology). If using 2014 Edition, see the “Transition” objectives

applicable for 2014 Edition users on the next page; these are slightly different.

*Required for Base Score, noting that your performance also contributes to your supplemental performance score.

Per CMS, “The performance score…is based on a MIPS eligible clinician’s performance rate for each measure reported for the

performance score (calculated using the numerator/denominator).” If your ratio is 90 out of 100 patients, for example, you’ll get 90% of

10 points, which is 9 points.

^Recommended, as “Yes” achieves the full 10 points.

Category Maximum # of Points

Provide Patient Access* 10

Patient-Specific Education 10

View, Download or Transmit 10

Secure Messaging 10

Patient-Generated Health Data 10

Send a Summary of Care* 10

Require/Accept Summary of Care* 10

Clinical Information Reconciliation 10

Immunization Registry^ 10

Bonus: (Any) Public Health/Clinical Data Registry^ 5

Bonus: Report your improvement activities using CEHRT^

10

Need 50

Points Here

to Maximize

Your

Performance

Score

(100)

155 Total

2015 Edition of CEHRT

This table reflects the 2014 Edition of CEHRT.

*Required for Base Score, noting that your performance also contributes to your supplemental performance score.

Per CMS, “The performance score…is based on a MIPS eligible clinician’s performance rate for each measure reported for the

performance score (calculated using the numerator/denominator).” If your ratio is 90 out of 100 patients, for example, you’ll get 90% of

10 points, which is 9 points.

^Recommended, as “Yes” achieves the full 10 points.

Category Maximum # of Points

Provide Patient Access* 20

Patient-Specific Education 10

View, Download or Transmit 10

Secure Messaging 10

Health Information Exchange* 20

Medication Reconciliation 10

Immunization Registry^ 10

Bonus: (Any) Public Health/Clinical Data Registry^ 5

Bonus: Report your improvement activities using CEHRT^

10

Need 50

Points to

Maximize

Your

Performance

Score

MIPS Category

Advancing Care Information

2014 Edition of CEHRT

2016©

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Regularly assess the patient experience of care through

surveys, advisory councils and/or other mechanisms.

Seeing new and follow-up Medicaid patients in a

timely manner, including individuals dually eligible for

Medicaid and Medicare (HIGH).

Timely communication of test results defined as timely

identification of abnormal test results with timely

follow-up.

Performance of regular practices that include providing

specialist reports back to the referring…clinician or

group to close the referral loop or where the referring

…clinician or group initiates regular inquiries to

specialist for specialist reports which could be

documented or noted in the certified EHR technology.

Implementation of regular care coordination training.

Improvement Activity

2016©

45

Elizabeth W. Woodcock, MBA, FACMPE, CPC

Woodcock & Associates

Speaker, Trainer, Author

Atlanta, Georgia

404.373.6195

[email protected]

www.elizabethwoodcock.com

These handouts may not be reproduced without the written consent of the speaker.

TOTAL 0% ORTHOPEDIC SURGERY 0%

ALLERGY/IMMUNOLOGY 1% OTOLARNGOLOGY -1%

ANESTHESIOLOGY 0% PATHOLOGY -1%

CARDIAC SURGERY 0% PEDIATRICS 0%

CARDIOLOGY 0% PHYSICAL MEDICINE 0%

COLON AND RECTAL SURGERY 0% PLASTIC SURGERY 0%

CRITICAL CARE 0% PSYCHIATRY 0%

DERMATOLOGY 0% PULMONARY DISEASE 0%

EMERGENCY MEDICINE 0% RADIATION ONCOLOGY 0%

ENDOCRINOLOGY 0% RADIOLOGY -1%

FAMILY PRACTICE 1% RHEUMATOLOGY 0%

GASTROENTEROLOGY -1% THORACIC SURGERY 0%

GENERAL PRACTICE 0% UROLOGY -2%

GENERAL SURGERY 0% VASCULAR SURGERY -1%

GERIATRICS 1% AUDIOLOGIST 0%

HAND SURGERY 0% CHIROPRACTOR 0%

HEMATOLOGY/ONCOLOGY 0% CLINICAL PSYCHOLOGIST 0%

INFECTIOUS DISEASE 0% CLINICAL SOCIAL WORKER 0%

INTERNAL MEDICINE 1% DIAGNOSTIC TESTING FACILITY -1%

INTERVENTIONAL PAIN MGMT 0% INDEPENDENT LABORATORY -5%

INTERVENTIONAL RADIOLOGY -1% NURSE ANES / ANES ASST 0%

MULTISPECIALTY CLINIC/OTHER 1% NURSE PRACTITIONER 0%

NEPHROLOGY 0% OPTOMETRY -1%

NEUROLOGY 0% PHYSICAL/OCCUPATIONAL THERAPY 1%

NEUROSURGERY -1% PHYSICIAN ASSISTANT 0%

NUCLEAR MEDICINE 0% PODIATRY 0%

OBSTETRICS/GYNECOLOGY 0% PORTABLE X-RAY SUPPLIER 0%

OPHTHALMOLOGY -2% RADIATION THERAPY CENTERS 0%

ORAL/MAXILLOFACIAL SURGERY -1% OTHER 0%

Source: Pages 1329-1330, Federal Register/November 15, 2016

(Link provided, but will be moved as of November 16 upon final publication)


Provided by Elizabeth Woodcock @ www.elizabethwoodcock.com

TABLE 62: CY 2017 PFS FINAL ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY SPECIALTY

Specialty

Combined

Impact (%) Specialty

Combined

Impact (%)


MEASURE NAME MEASURE DESCRIPTIONRequired

for Base

Performance

Score Weight

e-Prescribing

At least one permissible prescription written by the MIPS eligible

clinician is queried for a drug formulary and transmitted electronically Yes 0

Health Information Exchange

The MIPS eligible clinician that transitions or refers their patient to

another setting of care or health care clinician (1) uses CEHRT to create

a summary of care record; and (2) electronically transmits such

summary to a receiving health care clinician for at least one transition Yes Up to 20%

Immunization Registry

Reporting

The MIPS eligible clinician is in active engagement with a public health

agency to submit immunization data. No 0 or 10%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at

least one transition of care in which the patient is transitioned into the

care of the MIPS eligible clinician. No Up to 10%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from

CEHRT to identify patient-specific educational resources and provide

electronic access to those materials to at least one unique patient seen

by the MIPS eligible clinician. No Up to 10%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the

performance period is provided timely access to view online, download,

and transmit to a third party their health information subject to the

MIPS eligible clinician's discretion to withhold certain information. Yes Up to 20%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during

the performance period, a secure message was sent using the

electronic messaging function of CEHRT to the patient (or the patient-

authorized representative), or in response to a secure message sent by

the patient (or the patient-authorized representative) during the No Up to 10%

Security Risk Analysis

Conduct or review a security risk analysis... including addressing the

security (to include encryption) of ePHI data created or maintained by

certified EHR technology...and implement security updates as necessary

and correct identified security deficiencies as part of the MIPS eligible

clinician's risk management process. (See 45 CFR 164.) Yes 0

Specialized Registry Reporting

The MIPS eligible clinician is in active engagement to submit data to

specialized registry. Earn a 5% bonus in the advancing care information

performance category score for submitting to one or more public

health or clinical data registries. No 0

Syndromic Surveillance

Reporting

The MIPS eligible clinician is in active engagement with a public health

agency to submit syndromic surveillance data. Earn a 5% bonus in the

advancing care information performance category score for submitting

to one or more public health or clinical data registries. No 0

View, Download, or

Transmit (VDT)

At least one patient seen by the MIPS eligible clinician during the

performance period (or patient-authorized representative) views,

downloads or transmits their health information to a third party during

the performance period. No Up to 10%

Merit-based Incentive Payment SystemAdvancing Care Information - 2017 Requirements

Provided by Elizabeth W. Woodcock, MBA, FACMPE, CPC | Source: https://qpp.cms.gov/measures/aci

http://www.elizabethwoodcock.com/

ACTIVITY NAME ACTIVITY DESCRIPTIONACTIVITY

WEIGHTING

Additional improvements in access as a

result of QIN/QIO TA

As a result of Quality Innovation Network-Quality

Improvement Organization technical assistance, performance

of additional activities that improve access to services (e.g.,

investment of on-site diabetes educator). Medium

Administration of the AHRQ Survey of

Patient Safety Culture

Administration of the AHRQ Survey of Patient Safety Culture

and submission of data to the comparative database (refer to

AHRQ Survey of Patient Safety Culture website

http://www.ahrq.gov/professionals/quality-patient-

safety/patientsafetyculture/index.html) Medium

Annual registration in the Prescription

Drug Monitoring Program

Annual registration by eligible clinician or group in the

prescription drug monitoring program of the state where they

practice. Activities that simply involve registration are not

sufficient. MIPS eligible clinicians and groups must participate

for a minimum of 6 months. Medium

Merit-Based Incentive Payment SystemImprovement Activities - 2017 Requirements

Provided by Elizabeth W. Woodcock, MBA, FACMPE, CPC | Source: https://qpp.cms.gov

Anticoagulant management

improvements

MIPS eligible clinicians and groups who prescribe oral Vitamin K

antagonist therapy (warfarin) must attest that, in the first

performance year, 60 percent or more of their ambulatory care

patients receiving warfarin are being managed by one or more of

these clinical practice improvement activities: Patients are being

managed by an anticoagulant management service, that involves

systematic and coordinated care*, incorporating comprehensive

patient education, systematic INR testing, tracking, follow-up, and

patient communication of results and dosing decisions; Patients are

being managed according to validated electronic decision support

and clinical management tools that involve systematic and

coordinated care, incorporating comprehensive patient education,

systematic INR testing, tracking, follow-up, and patient

communication of results and dosing decisions; For rural or remote

patients, patients are managed using remote monitoring or

telehealth options that involve systematic and coordinated care,

incorporating comprehensive patient education, systematic INR

testing, tracking, follow-up, and patient communication of results

and dosing decisions; and/or For patients who demonstrate

motivation, competency, and adherence, patients are managed using

either a patient self-testing (PST) or patient-self-management (PSM)

program. The performance threshold will increase to 75 percent for

the second performance year and onward. Clinicians would attest

that, 60 percent for first year, or 75 percent for the second year, of

their ambulatory care patients receiving warfarin participated in an

anticoagulation management program for at least 90 days during the

performance period. High

Care coordination agreements that

promote improvements in patient tracking

across settings

Establish effective care coordination and active referral

management that could include one or more of the following:

Establish care coordination agreements with frequently used

consultants that set expectations for documented flow of

information and MIPS eligible clinician or MIPS eligible

clinician group expectations between settings. Provide

patients with information that sets their expectations

consistently with the care coordination agreements; Track

patients referred to specialist through the entire process;

and/or Systematically integrate information from referrals into

the plan of care. Medium

Care transition documentation practice

improvements

Implementation of practices/processes for care transition that

include documentation of how a MIPS eligible clinician or

group carried out a patient-centered action plan for first 30

days following a discharge (e.g., staff involved, phone calls

conducted in support of transition, accompaniments,

navigation actions, home visits, patient information access,

etc.). Medium


Care transition standard operational

improvements

Establish standard operations to manage transitions of care

that could include one or more of the following: Establish

formalized lines of communication with local settings in which

empaneled patients receive care to ensure documented flow

of information and seamless transitions in care; and/or

Partner with community or hospital-based transitional care

services. Medium

Chronic care and preventative care

management for empanelled patients

Proactively manage chronic and preventive care for

empaneled patients that could include one or more of the

following: Provide patients annually with an opportunity for

development and/or adjustment of an individualized plan of

care as appropriate to age and health status, including health

risk appraisal; gender, age and condition-specific preventive

care services; plan of care for chronic conditions; and advance

care planning; Use condition-specific pathways for care of

chronic conditions (e.g., hypertension, diabetes, depression,

asthma and heart failure) with evidence-based protocols to

guide treatment to target; Use pre-visit planning to optimize

preventive care and team management of patients with

chronic conditions; Use panel support tools (registry

functionality) to identify services due; Use reminders and

outreach (e.g., phone calls, emails, postcards, patient portals

and community health workers where available) to alert and

educate patients about services due; and/or Routine

medication reconciliation. Medium

CMS partner in Patients Hospital

Engagement Network

Membership and participation in a CMS Partnership for

Patients Hospital Engagement Network. Medium

Collection and follow-up on patient

experience and satisfaction data on

beneficiary engagement

Collection and follow-up on patient experience and

satisfaction data on beneficiary engagement, including

development of improvement plan. High

Collection and use of patient experience

and satisfaction data on access

Collection of patient experience and satisfaction data on

access to care and development of an improvement plan, such

as outlining steps for improving communications with patients

to help understanding of urgent access needs. Medium

Completion of the AMA STEPS Forward

program

Completion of the American Medical Association's STEPS

Forward program. Medium

Completion of training and receipt of

approved waiver for provision opioid

medication-assisted treatments

Completion of training and obtaining an approved waiver for

provision of medication-assisted treatment of opioid use

disorders using buprenorphine. Medium

Consultation of the Prescription Drug

Monitoring program

Clinicians would attest that, 60 percent for first year, or 75

percent for the second year, of consultation of prescription

drug monitoring program prior to the issuance of a Controlled

Substance Schedule II (CSII) opioid prescription that lasts for

longer than 3 days. High


Depression screening

Depression screening and follow-up plan: Regular

engagement of MIPS eligible clinicians or groups in integrated

prevention and treatment interventions, including depression

screening and follow-up plan (refer to NQF #0418) for patients

with co-occurring conditions of behavioral or mental health

conditions. Medium

Diabetes screening

Diabetes screening for people with schizophrenia or bipolar

disease who are using antipsychotic medication. Medium

Electronic Health Record Enhancements

for BH data capture

Enhancements to an electronic health record to capture

additional data on behavioral health (BH) populations and use

that data for additional decision-making purposes (e.g.,

capture of additional BH data results in additional depression

screening for at-risk patient not previously identified). Medium

Engagement of community for health

status improvement

Take steps to improve health status of communities, such as

collaborating with key partners and stakeholders to

implement evidenced-based practices to improve a specific

chronic condition. Refer to the local Quality Improvement

Organization (QIO) for additional steps to take for improving

health status of communities as there are many steps to select

from for satisfying this activity. QIOs work under the direction

of CMS to assist MIPS eligible clinicians and groups with

quality improvement, and review quality concerns for the

protection of beneficiaries and the Medicare Trust Fund. Medium

Engagement of new Medicaid patients and

follow-up

Seeing new and follow-up Medicaid patients in a timely

manner, including individuals dually eligible for Medicaid and

Medicare. High

Engagement of patients, family and

caregivers in developing a plan of care

Engage patients, family and caregivers in developing a plan of

care and prioritizing their goals for action, documented in the

certified EHR technology. Medium

Engagement of patients through

implementation of improvements in

patient portal

Access to an enhanced patient portal that provides up to date

information related to relevant chronic disease health or

blood pressure control, and includes interactive features

allowing patients to enter health information and/or enables

bidirectional communication about medication changes and

adherence. Medium

Engagement with QIN-QIO to implement

self-management training programs

Engagement with a Quality Innovation Network-Quality

Improvement Organization, which may include participation in

self-management training programs such as diabetes. Medium

Engage patients and families to guide

improvement in the system of care.

Engage patients and families to guide improvement in the

system of care. Medium


Enhancements/regular updates to practice

websites/tools that also include

considerations for patients with cognitive

disabilities

Enhancements and ongoing regular updates and use of

websites/tools that include consideration for compliance with

section 508 of the Rehabilitation Act of 1973 or for improved

design for patients with cognitive disabilities. Refer to the CMS

website on Section 508 of the Rehabilitation Act

https://www.cms.gov/Research-Statistics-Data-and-

Systems/CMS-Information-

Technology/Section508/index.html?redirect=/InfoTechGenInf

o/07_Section508.asp that requires that institutions receiving

federal funds solicit, procure, maintain and use all electronic

and information technology (EIT) so that equal or

alternate/comparable access is given to members of the public

with and without disabilities. For example, this includes

designing a patient portal or website that is compliant with

section 508 of the Rehabilitation Act of 1973 Medium

Evidenced-based techniques to promote

self-management into usual care

Incorporate evidence-based techniques to promote self-

management into usual care, using techniques such as goal

setting with structured follow-up, Teach Back, action planning

or motivational interviewing. Medium

Glycemic management services

For outpatient Medicare beneficiaries with diabetes and who

are prescribed antidiabetic agents (e.g., insulin, sulfonylureas),

MIPS eligible clinicians and groups must attest to having: For

the first performance year, at least 60 percent of medical

records with documentation of an individualized glycemic

treatment goal that: a) Takes into account patient-specific

factors, including, at least 1) age, 2) comorbidities, and 3) risk

for hypoglycemia, and b) Is reassessed at least annually. The

performance threshold will increase to 75 percent for the

second performance year and onward. Clinician would attest

that, 60 percent for first year, or 75 percent for the second

year, of their medical records that document individualized

glycemic treatment represent patients who are being treated

for at least 90 days during the performance period. High

Implementation of additional activity as a

result of TA for improving care

coordination

Implementation of at least one additional recommended

activity from the Quality Innovation Network-Quality

Improvement Organization after technical assistance has been

provided related to improving care coordination. Medium


Implementation of analytic capabilities to

manage total cost of care for practice

population

Build the analytic capability required to manage total cost of

care for the practice population that could include one or

more of the following: Train appropriate staff on

interpretation of cost and utilization information; and/or Use

available data regularly to analyze opportunities to reduce

cost through improved care. Medium

Implementation of antibiotic stewardship

program

Implementation of an antibiotic stewardship program that

measures the appropriate use of antibiotics for several

different conditions (URI Rx in children, diagnosis of

pharyngitis, Bronchitis Rx in adults) according to clinical

guidelines for diagnostics and therapeutics Medium

Implementation of co-location PCP and

MH services

Integration facilitation, and promotion of the colocation of

mental health services in primary and/or non-primary clinical

care settings. High

Implementation of condition-specific

chronic disease self-management support

programs

Provide condition-specific chronic disease self-management

support programs or coaching or link patients to those

programs in the community. Medium

Implementation of documentation

improvements for practice/process

improvements

Implementation of practices/processes that document care

coordination activities (e.g., a documented care coordination

encounter that tracks all clinical staff involved and

communications from date patient is scheduled for outpatient

procedure through day of procedure). Medium

Implementation of episodic care

management practice improvements

Provide episodic care management, including management

across transitions and referrals that could include one or more

of the following: Routine and timely follow-up to

hospitalizations, ED visits and stays in other institutional

settings, including symptom and disease management, and

medication reconciliation and management; and/or Managing

care intensively through new diagnoses, injuries and

exacerbations of illness. Medium

Implementation of fall screening and

assessment programs

Implementation of fall screening and assessment programs to

identify patients at risk for falls and address modifiable risk

factors (e.g., Clinical decision support/prompts in the

electronic health record that help manage the use of

medications, such as benzodiazepines, that increase fall risk). Medium


Implementation of formal quality

improvement methods, practice changes

or other practice improvement processes

Adopt a formal model for quality improvement and create a

culture in which all staff actively participates in improvement

activities that could include one or more of the following:

Train all staff in quality improvement methods; Integrate

practice change/quality improvement into staff duties; Engage

all staff in identifying and testing practices changes; Designate

regular team meetings to review data and plan improvement

cycles; Promote transparency and accelerate improvement by

sharing practice level and panel level quality of care, patient

experience and utilization data with staff; and/or Promote

transparency and engage patients and families by sharing

practice level quality of care, patient experience and utilization

data with patients and families. Medium

Implementation of improvements that

contribute to more timely communication

of test results

Timely communication of test results defined as timely

identification of abnormal test results with timely follow-up. Medium

Implementation of integrated PCBH model

Offer integrated behavioral health services to support patients

with behavioral health needs, dementia, and poorly controlled

chronic conditions that could include one or more of the

following: Use evidence-based treatment protocols and

treatment to goal where appropriate; Use evidence-based

screening and case finding strategies to identify individuals at

risk and in need of services; Ensure regular communication

and coordinated workflows between eligible clinicians in

primary care and behavioral health; Conduct regular case

reviews for at-risk or unstable patients and those who are not

responding to treatment; Use of a registry or certified health

information technology functionality to support active care

management and outreach to patients in treatment; and/or

Integrate behavioral health and medical care plans and

facilitate integration through co-location of services when

feasible. High

Implementation of medication

management practice improvements

Manage medications to maximize efficiency, effectiveness and

safety that could include one or more of the following:

Reconcile and coordinate medications and provide medication

management across transitions of care settings and eligible

clinicians or groups; Integrate a pharmacist into the care

team; and/or Conduct periodic, structured medication

reviews. Medium


Implementation of methodologies for

improvements in longitudinal care

management for high risk patients

Provide longitudinal care management to patients at high risk

for adverse health outcome or harm that could include one or

more of the following: Use a consistent method to assign and

adjust global risk status for all empaneled patients to allow

risk stratification into actionable risk cohorts. Monitor the risk-

stratification method and refine as necessary to improve

accuracy of risk status identification; Use a personalized plan

of care for patients at high risk for adverse health outcome or

harm, integrating patient goals, values and priorities; and/or

Use on-site practice-based or shared care managers to

proactively monitor and coordinate care for the highest risk

cohort of patients. Medium

Implementation of practices/processes for

developing regular individual care plans

Implementation of practices/processes to develop regularly

updated individual care plans for at-risk patients that are

shared with the beneficiary or caregiver(s). Medium

Implementation of use of specialist

reports back to referring clinician or group

to close referral loop

Performance of regular practices that include providing

specialist reports back to the referring MIPS eligible clinician or

group to close the referral loop or where the referring MIPS

eligible clinician or group initiates regular inquiries to

specialist for specialist reports which could be documented or

noted in the certified EHR technology. Medium

Improved practices that disseminate

appropriate self-management materials

Provide self-management materials at an appropriate literacy

level and in an appropriate language. Medium

Improved practices that engage patients

pre-visit

Provide a pre-visit development of a shared visit agenda with

the patient. Medium

Integration of patient coaching practices

between visits

Provide coaching between visits with follow-up on care plan

and goals. Medium

Leadership engagement in regular

guidance and demonstrated commitment

for implementing practice improvement

changes

Ensure full engagement of clinical and administrative

leadership in practice improvement that could include one or

more of the following: Make responsibility for guidance of

practice change a component of clinical and administrative

leadership roles; Allocate time for clinical and administrative

leadership for practice improvement efforts, including

participation in regular team meetings; and/or Incorporate

population health, quality and patient experience metrics in

regular reviews of practice performance. Medium


Leveraging a QCDR for use of standard

questionnaires

Participation in a QCDR, demonstrating performance of

activities for use of standard questionnaires for assessing

improvements in health disparities related to functional health

status (e.g., use of Seattle Angina Questionnaire, MD

Anderson Symptom Inventory, and/or SF-12/VR-12 functional

health status assessment). Medium

Leveraging a QCDR to promote use of

patient-reported outcome tools


activities for promoting use of patient-reported outcome

(PRO) tools and corresponding collection of PRO data (e.g., use

of PQH-2 or PHQ-9 and PROMIS instruments). Medium

Leveraging a QCDR to standardize

processes for screening


activities for use of standardized processes for screening for

social determinants of health such as food security,

employment and housing. Use of supporting tools that can be

incorporated into the certified EHR technology is also

suggested. Medium

MDD prevention and treatment

interventions

Major depressive disorder: Regular engagement of MIPS

eligible clinicians or groups in integrated prevention and

treatment interventions, including suicide risk assessment

(refer to NQF #0104) for mental health patients with co-

occurring conditions of behavioral or mental health

conditions. Medium

Measurement and improvement at the

practice and panel level

Measure and improve quality at the practice and panel level

that could include one or more of the following: Regularly

review measures of quality, utilization, patient satisfaction and

other measures that may be useful at the practice level and at

the level of the care team or MIPS eligible clinician or

group(panel); and/or Use relevant data sources to create

benchmarks and goals for performance at the practice level

and panel level. Medium

Participate in IHI Training/Forum Event;

National Academy of Medicine, AHRQ

Team STEPPS(R) or other similar activity.

For eligible professionals not participating in Maintenance of

Certification (MOC) Part IV, new engagement for MOC Part IV,

such as IHI Training/Forum Event; National Academy of

Medicine, AHRQ Team STEPPS(R) Medium

Participation in a 60-day or greater effort

to support domestic or international

humanitarian needs.

Participation in domestic or international humanitarian

volunteer work. Activities that simply involve registration are

not sufficient. MIPS eligible clinicians attest to domestic or

international humanitarian volunteer work for a period of a

continuous 60 days or greater. High

Participation in an AHRQ-listed patient

safety organization. Participation in an AHRQ-listed patient safety organization. Medium


Participation in a QCDR, that promotes

collaborative learning network

opportunities that are interactive.

Participation in a QCDR, that promotes collaborative learning

network opportunities that are interactive. Medium


implementation of patient self-action

plans.

Participation in a QCDR, that promotes implementation of

patient self-action plans. Medium


use of patient engagement tools.

Participation in a QCDR, that promotes use of patient

engagement tools. Medium


use of processes and tools that engage

patients for adherence to treatment plan.

Participation in a QCDR, that promotes use of processes and

tools that engage patients for adherence to treatment plan. Medium

Participation in Bridges to Excellence or

other similar program

Participation in other quality improvement programs such as

Bridges to Excellence Medium

Participation in CAHPS or other

supplemental questionnaire

Participation in the Consumer Assessment of Healthcare

Providers and Systems Survey or other supplemental

questionnaire items (e.g., Cultural Competence or Health

Information Technology supplemental item sets). High

Participation in CMMI models such as

Million Hearts Campaign

Participation in CMMI models such as the Million Hearts

Cardiovascular Risk Reduction Model Medium

Participation in Joint Commission

Evaluation Initiative

Participation in Joint Commission Ongoing Professional

Practice Evaluation initiative Medium

Participation in MOC Part IV

Participation in Maintenance of Certification (MOC) Part IV for

improving professional practice including participation in a

local, regional or national outcomes registry or quality

assessment program. Performance of monthly activities across

practice to regularly assess performance in practice, by

reviewing outcomes addressing identified areas for

improvement and evaluating the results. Medium

Participation in population health research

Participation in research that identifies interventions, tools or

processes that can improve a targeted patient population. Medium

Participation in private payer CPIA

Participation in designated private payer clinical practice

improvement activities. Medium

Participation in systematic anticoagulation

program

Participation in a systematic anticoagulation program

(coagulation clinic, patient self-reporting program, patient self-

management program)for 60 percent of practice patients in

year 1 and 75 percent of practice patients in year 2 who

receive anti-coagulation medications (warfarin or other

coagulation cascade inhibitors). High


Participation on Disaster Medical

Assistance Team, registered for 6 months.

Participation in Disaster Medical Assistance Teams, or

Community Emergency Responder Teams. Activities that

simply involve registration are not sufficient. MIPS eligible

clinicians and MIPS eligible clinician groups must be registered

for a minimum of 6 months as a volunteer for disaster or

emergency response. Medium

Population empanelment

Empanel (assign responsibility for) the total population, linking

each patient to a MIPS eligible clinician or group or care team.

Empanelment is a series of processes that assign each active

patient to a MIPS eligible clinician or group and/or care team,

confirm assignment with patients and clinicians, and use the

resultant patient panels as a foundation for individual patient

and population health management. Empanelment identifies

the patients and population for whom the MIPS eligible

clinician or group and/or care team is responsible and is the

foundation for the relationship continuity between patient

and MIPS eligible clinician or group /care team that is at the

heart of comprehensive primary care. Effective empanelment

requires identification of the active population" of the

practice: those patients who identify and use your practice as

a source for primary care. There are many ways to define

"active patients" operationally allowing inclusion of younger

patients who have minimal acute or preventive health care." Medium

Practice improvements for bilateral

exchange of patient information

Ensure that there is bilateral exchange of necessary patient

information to guide patient care that could include one or

more of the following: Participate in a Health Information

Exchange if available; and/or Use structured referral notes. Medium

Practice improvements that engage

community resources to support patient

health goals

Develop pathways to neighborhood/community-based

resources to support patient health goals that could include

one or more of the following: Maintain formal (referral) links

to community-based chronic disease self-management

support programs, exercise programs and other wellness

resources with the potential for bidirectional flow of

information; and/or Provide a guide to available community

resources. Medium


Provide 24/7 access to eligible clinicians or

groups who have real-time access to

patient's medical record

Provide 24/7 access to MIPS eligible clinicians, groups, or care

teams for advice about urgent and emergent care (e.g.,

eligible clinician and care team access to medical record, cross-

coverage with access to medical record, or protocol-driven

nurse line with access to medical record) that could include

one or more of the following: Expanded hours in evenings and

weekends with access to the patient medical record (e.g.,

coordinate with small practices to provide alternate hour

office visits and urgent care); Use of alternatives to increase

access to care team by MIPS eligible clinicians and groups,

such as e-visits, phone visits, group visits, home visits and

alternate locations (e.g., senior centers and assisted living

centers); and/or Provision of same-day or next-day access to

a consistent MIPS eligible clinician, group or care team when

needed for urgent care or transition management High

Provide peer-led support for self-

management. Provide peer-led support for self-management. Medium

Regularly assess the patient experience of

care through surveys, advisory councils

and/or other mechanisms.

Regularly assess the patient experience of care through

surveys, advisory councils and/or other mechanisms. Medium

Regular review practices in place on

targeted patient population needs

Implementation of regular reviews of targeted patient

population needs which includes access to reports that show

unique characteristics of eligible professional's patient

population, identification of vulnerable patients, and how

clinical treatment needs are being tailored, if necessary, to

address unique needs and what resources in the community

have been identified as additional resources. Medium

Regular training in care coordination Implementation of regular care coordination training. Medium

RHC, IHS or FQHC quality improvement

activities

Participating in a Rural Health Clinic (RHC), Indian Health

Service Medium Management (IHS), or Federally Qualified

Health Center in ongoing engagement activities that

contribute to more formal quality reporting in line with

Section 1848(q)(2)(B)(iii) of the Act that requires the Secretary

to give consideration to the circumstances of practices located

in rural areas and geographic HPSAs. Rural Health Clinics

would be included in that definition for consideration of

practices in rural areas. High

TCPI participation

Participation in the CMS Transforming Clinical Practice

Initiative. High


Tobacco use

Tobacco use: Regular engagement of MIPS eligible clinicians or

groups in integrated prevention and treatment interventions,

including tobacco use screening and cessation interventions

(refer to NQF #0028) for patients with co-occurring conditions

of behavioral or mental health and at risk factors for tobacco

dependence. Medium

Unhealthy alcohol use

Unhealthy alcohol use: Regular engagement of MIPS eligible

clinicians or groups in integrated prevention and treatment

interventions, including screening and brief counseling (refer

to NQF #2152) for patients with co-occurring conditions of

behavioral or mental health conditions. Medium

Use evidence-based decision aids to

support shared decision-making.

Use evidence-based decision aids to support shared decision-

making. Medium

Use group visits for common chronic

conditions (e.g., diabetes).

Use group visits for common chronic conditions (e.g.,

diabetes). Medium

Use of certified EHR to capture patient

reported outcomes

In support of improving patient access, performing additional

activities that enable capture of patient reported outcomes

(e.g., home blood pressure, blood glucose logs, food diaries, at-

risk health factors such as tobacco or alcohol use, etc.) or

patient activation measures through use of certified EHR

technology, containing this data in a separate queue for

clinician recognition and review. Medium

Use of decision support and standardized

treatment protocols

Use decision support and standardized treatment protocols to

manage workflow in the team to meet patient needs. Medium

Use of patient safety tools

Use of tools that assist specialty practices in tracking specific

measures that are meaningful to their practice, such as use of

the Surgical Risk Calculator. Medium

Use of QCDR data for ongoing practice

assessment and improvements

Use of QCDR data, for ongoing practice assessment and

improvements in patient safety. Medium

Use of QCDR data for quality

improvement such as comparative

analysis reports across patient populations

Participation in a QCDR, clinical data registries, or other

registries run by other government agencies such as FDA, or

private entities such as a hospital or medical or surgical

society. Activity must include use of QCDR data for quality

improvement (e.g., comparative analysis across specific

patient populations for adverse outcomes after an outpatient

surgical procedure and corrective steps to address adverse

outcome). Medium

Use of QCDR for feedback reports that

incorporate population health

Use of a QCDR to generate regular feedback reports that

summarize local practice patterns and treatment outcomes,

including for vulnerable populations. High


Use of QCDR patient experience data to

inform and advance improvements in

beneficiary engagement.

Use of QCDR patient experience data to inform and advance

improvements in beneficiary engagement. Medium

Use of QCDR to promote standard

practices, tools and processes in practice

for improvement in care coordination

Participation in a Qualified Clinical Data Registry,

demonstrating performance of activities that promote use of

standard practices, tools and processes for quality

improvement (e.g., documented preventative screening and

vaccinations that can be shared across MIPS eligible clinician

or groups). Medium

Use of QCDR to support clinical decision

making


activities that promote implementation of shared clinical

decision making capabilities. Medium

Use of telehealth services that expand

practice access

Use of telehealth services and analysis of data for quality

improvement, such as participation in remote specialty care

consults or teleaudiology pilots that assess ability to still

deliver quality care to patients. Medium

Use of toolsets or other resources to close

healthcare disparities across communities

Take steps to improve healthcare disparities, such as

Population Health Toolkit or other resources identified by

CMS, the Learning and Action Network, Quality Innovation

Network, or National Coordinating Center. Refer to the local

Quality Improvement Organization (QIO) for additional steps

to take for improving health status of communities as there

are many steps to select from for satisfying this activity. QIOs

work under the direction of CMS to assist eligible clinicians

and groups with quality improvement, and review quality

concerns for the protection of beneficiaries and the Medicare

Trust Fund. Medium

Use of tools to assist patient self-

management

Use tools to assist patients in assessing their need for support

for self-management (e.g., the Patient Activation Measure or

How's My Health). Medium













Performance Period Measure TypeSubmission

Mechanism

Submission Criteria Data Completeness

A minimum of one

continous 90-day

period during CY2017

Individual

MIPS eligible

clinicans

Part B Claims Report at least six measures

including one outcome measure,

or if an outcome measure is not

available report another high

priority measure, if less than six

measures apply then report on

each measure that is applicale.

MIPS eligible clinicans and

groups will have to select their

measures from either the list of all

MIPS Measures in Table A or a

set of specialty-specific measures

in Table E.

50 percent of MIPS

eligible clinician’s

Medicare Part B patients

for the performance

period

A minimum of one

continuous 90-day

period during CY2017

Individual

MIPS eligible

clinicians or

Groups

QCDR

Qualified

Registry EHR

Report at least six measures

including one outcome measure,

or if an outcome measure is not

available report another high

priority measure; if less than six

measures apply then report on

each measure that is applicable.

MIPS eligible clinicians and

groups will have to select their

measures from either the list of all

MIPS Measures in Table A or a

set of specialty-specific measures

in Table E.

50 percent of MIPS

eligible clinician’s or

groups patients across

all payers for the

performance period

Jan 1- Dec 31 Groups CMS Web

Interface

Report on all measures included

in the CMS Web Interface; AND

populate data fields for the first

248 consecutively ranked and

assigned Medicare beneficiaries

in the order in which they appear

in the group’s sample for each

module/measure. If the pool of

eligible assigned beneficiaries is

less than 248, then the group

would report on 100 percent of

assigned beneficiaries.

Sampling requirements

for their Medicare Part B

patients

Table 5: Summary of Final Quality Data Submission Criteria for MIPS Payment Year 2019 via Part B Claims,

QCDR, Qualified Registry, EHR, CMS Web Interface, and CAHPS for MIPS Survey

Jan 1- Dec 31 Groups CAHPS for

MIPS Survey

CMS-approved survey vendor

would have to be paired with

another reporting mechanism to

ensure the minimum number of

measures are reported. CAHPS

for MIPS Survey would fulfill the

requirement for one patient

experience measure towards the

MIPS quality data submission

criteria. CAHPS for MIPS Survey

will only count for one measure.

Sampling requirements

for their Medicare Part B

patients

Source: https://qpp.cms.gov/docs/CMS-5517-FC.pdf. Pages 434-435.

Documents

TABLE 11: Summary of CY 2017 Chronic Care Management (CCM ...€¦ · TABLE 11: Summary of CY 2017 Chronic Care Management (CCM) Service Elements and Billing Requirements Initiating