Embed Size (px)
Citation preview
2019 CMS Web Interface Quality Reporting for MIPS Groups and ACOs
CMS Web Interface Support Call
March 4, 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 6 (Recorded 02/19/2020)
• 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 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 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
• 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
FREQUENTLY ASKED MEASURE QUESTIONS
Presenter: Angela Stevenson, CMS Contractor
8
CARE-2: Falls: Screening for Future Fall Risk
9
No. Question Answer
1 What documentation is required to meet the intent of the CARE-2 measure?
As defined on page 5 of the 2019 CARE-2 measure specification, screening for future fall risk is an assessment of whether an individual has experienced a fall or problems with gait or balance. There must be documentation in the medical record of a falls risk screening that includes one of the following: 1) the patient's history of falls, 2) a described fall, 3) a note stating 'no falls', or 4) an assessment of gait or balance.
If, after reviewing the medical record, you find supporting documentation that meets the numerator guidance criteria then it would meet the intent of this measure and you would select "Yes.”
MH-1: Depression Remission at Twelve Months
10
No. Question Answer
1 If we have documentation of “major depression” with a PHQ-9 score of 8, can the patient be confirmed for the denominator?
No. The patient must have both a diagnosis of major depression or dysthymia AND a PHQ-9 or PHQ-9M greater than 9 during the denominator identification period to be included in the denominator.
If the patient does not have a PHQ-9 or PHQ-9M greater than 9, select "No“ to the question, “did the patient have a PHQ-9 or PHQ-9M greater than 9 during the denominator identification period (November 1, 2017 and October 31, 2018)?”
If "No" is selected, the patient will be "skipped" and another patient must be submitted in their place, if available.
2 If a patient answers the first two questions “not at all” and the rest of the questions are blank, isthe depression screening considered numerator compliant?
No. Per the 2019 MH-1 web interface measure specifications guidance:• Page 6 - Remission is defined as a PHQ-9 or PHQ-9M
score of less than five.• Page 12 - All nine questions must be answered to have
a valid summary score.
PREV-12: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
11
No. Question Answer
1 What documentation is acceptable to meet the intent of the 2019 PREV-12 measure?
For CMS Web Interface users with an electronic health record (EHR) that currently reflects the 2018 PREV-12 measure specifications, CMS will accept the same types of documentation you submitted during the 2018 submission period for the 2019 performance year.
Similarly, if your current EHR has been developed based on the 2019 PREV-12 measure specifications, CMS will accept documentation that aligns with the 2019 measure specifications.
For questions that are specific to your organization regarding acceptable documentation, please submit questions to the Quality Payment Program Service Center.
PREV-13: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
12
Measure Question Answer
MH-1 For the MH-1 measure, if there is a diagnosis code in the medical record that is included in the CMS Coding document denominator codes, but the description is "depressive disorder“ with no mention of "major depression“, can the code be used to confirm diagnosis?
Yes. A diagnosis code on the encounter or problem list (regardless of vendor assigned description of the code) can be used to confirm the diagnosis of major depression or dysthymia.
Please refer to the 2019 CMS Web Interface Coding document for diagnosis codes that can be used to confirm the diagnosis for the denominator.
PREV-13 Are additional statin medications acceptable to meet the measure other than what is listed in the numerator drug codes in the PREV Coding document?
Any statin therapy is acceptable. Both generic and brand name statins are acceptable.
The coding documents are considered all-inclusive for the purposes of EHR mapping however, you can use medical record documentation to meet the intent of the measure.
No. Question Answer
1 Is a diagnosis of "Hypercholesterolemia" sufficient for meeting Population 2 or does it specifically have to say "Familial" or "Pure Hypercholesterolemia"?
Diagnosis of Familial or Pure Hypercholesterolemia are the only acceptable diagnosis that may be utilized for category 2 confirmation. Hypercholesterolemia alone is not considered an appropriate diagnosis for denominator confirmation. Please refer to the HTN coding document, “DenominatorCodes” for a list of appropriate diagnosis for PREV-13.
2 Is a patient allergy to one statin acceptable for the denominator exception or must they be allergic to all statins?
No. The patient does not have to be allergic to all statins. A listing of drugs that may be used for the Denominator Exception can be found on the “DenominatorExceptionDrugCodes” tab of the PREV coding document. These drugs may be used as a Denominator Exception if present in the patient's record accompanied by an appropriate conditional reason why the patient isn't taking the drug (e.g. adverse effect, allergy, or intolerance to statin medication).
Guidance provided on page 14 of the posted specification includes the following; “Denominator Exception should be active during the measurement period.”
Understanding Denominator Exclusions and Exceptions
• Denominator Exclusion - Patients who should be removed from the measure population and denominator before determining whether numerator criteria are met.
• Denominator Exception –When a patient falls into the denominator, but the measure specifications define circumstances in which a patient may be appropriately deemed as a denominator exception. Allowable reasons fall into three general categories:
- Medical
- Patient
- System
A denominator exception removes a patient from the performance denominator only if the numerator criteria are not met as defined by the exception. This allows for the exercise of clinical judgement by the MIPS eligible clinician.
13
Reporting Denominator Exclusions and Exceptions
14
No. Question Answer
1 If a patient meets performance for a measure, but there is an applicable denominator exclusion, which should be reported?
If a denominator exclusion applies to a patient, the exclusion should always be reported regardless of whether or not the quality action was completed for that patient.
This ensures the intended denominator population is captured for the measure.
2 If a patient meets performance for a measure, but there is an applicable denominator exception, which should be reported?
If there is documentation to support the quality action was completed for the patient (performance met) AND the patient has an applicable denominator exception, it would be appropriate to report “performance met.”
If the quality action was not completed for the patient and there is an applicable denominator exception, it would be appropriate to report the denominator exception.
RESOURCES & WHERE TO GO FOR HELPPresenter: Aruna Jhasti, CMS
15
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
16
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
- CMS Web Interface Weekly Support Call: Session 6 (Recorded 02/19/2020)
• Recording, Slides, Transcript17
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
18
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]
19
20
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.
21
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]
22
