Denali v3.1b1/onc 2015 Edition Webinar QPP/MU Settings Master & Reports

Transcription

1 Denali v3.1b1/onc 2015 Edition Webinar QPP/MU Settings Master & Reports Bizmatics, Inc Moorpark Avenue, Suite 222 San Jose, CA Copyright 2017 Bizmatics, Inc.

2 In this session CMS Quality Programs Overview CMS Quality Programs for 2017 Quality Payment Program MIPS Quality Payment Program AAPM EHR Incentive Program Meaningful Use MIPS Eligibility/Participation Pick Your Pace Reporting options MIPS Requirements QPP/MU Settings Master Clinic Setup Provider Setup Measure Selection & Requirements QPP/MU Reports MIPS Quality Claims Based Screen Appendix A QPP MIPS Weightage/Scoring Examples

3 Overview of CMS Quality Programs

4 Quality Payment Programs for Medicare & Medicaid* QPP (Quality Payment Program) Replaces EHR Incentive/Meaningful Use for Medicare providers MACRA umbrella Includes two performance-based tracks: MIPS and AAPM which replace traditional Medicare Fee For Service MIPS (Merit-based Incentive Payment System) Combines 3 legacy programs + adds one new performance category Note: For 2017 the Cost category is not applicable. A performance MIPS Score is calculated for the EC from all categories 2017 Focus AAPM (Advanced Alternative Payment Model) Providers may register to participate and CMS must approve you Incentive payments based on innovative payment models EHR Incentive Program/Meaningful Use (MU) Ended in 2016 for Medicare providers Continues through 2021 for Medicaid providers Check with your state agency for specifics *See MACRA-MIPS & MU for 2017 Webinar for more details.

5 MIPS Participation Eligible Clinician s NPI

6 MIPS Participation Status (Example) EC may be eligible individually EC may be eligible as part of a group but not individually EC may be eligible both as an individual & as part of a group EC may be part of multiple groups and have different designation with each one EC may be totally exempt

7 Pick Your Pace for 2017 Participation Level Payment adjustment in 2019 is based upon your level of participation in 2017 Determines the amount of data you must report No Participation negative 4% payment adjustment in 2019 Note: An ineligible EC will not receive a negative adjustment. Test/Minimal Participation zero payment adjustment in 2019 Submit some data for at least 1 category for any number of days Base all 5 measures required for any quantity of data/number of days Quality/IA at least 1 measure for any quantity of data/number of days Partial Participation neutral or small positive payment adjustment in 2019 Submit at least 90 days worth of data (must begin collection by Oct. 2 at latest) Base all 5 measures required Quality minimum of 6 measures required IA 40 points required Full Participation up to possible maximum positive 4% payment adjustment in 2019 Submit a full year of data for all categories Same requirements as the Partial Participation above

8 MIPS Requirements Consists of 3 existing quality reporting programs combined with 1 new category Quality (60%) replaces former PQRS (Physician Quality Reporting System) Improvement Activities (15%) new performance category Advancing Care Information (25%) replaces former MU (Meaningful Use) Note: Consists of 3 categories; all Base measures are mandatory. Cost replaces the Value Based Modifier (n/a for 2017) ECs may choose the amount of data and duration of days for which to report data CMS will apply payment adjustment based upon the EC s final MIPS Score*. *See Appendix A QPP MIPS Weightage/Scoring

9 QPP/MU Settings Master

10 QPP/MU Settings* Applicable to all providers for both QPP & MU. Each reporting provider must be defined. Accordion UI reflects the selected provider s programs & lets you manage the measures accordingly. *Settings Configuration MU/QPP Settings

11 Clinic Setup Displays status of each Encounter Type as relates to MU and QPP/MIPS ACI Note: This requires setup in Encounter Type MU Details. 2. Identifies status of Public Health Reporting measures for MU and QPP/MIPS ACI Immunization Information Syndromic Information NAMCS (National Ambulatory Medical Care Survey) 3. CCD Reporting fields Height Weight BP Smoking 4. Additional Setup lets you request interfaces as required if not already enabled.

12 Additional Setup 1. Controls the dashboards at they system and/or encounter level 2. Allows user to request required setup directly from Interface Team 3. Displays the status of the various processes or interfaces 1 2 3

13 Provider Setup 1a 1b Select each (a) Provider and (b) Year for which specifications will be applied 2. Select the Program(s) the selected provider will be reporting for the indicated year Note: A provider may choose QPP only, MU only, both, or None. a. Quality Payment Program for Medicare-eligible clinicians/providers MIPS (Merit-based Incentive Payment System) AAPM (Advanced Alternate Payment Model) b. EHR Incentive/Meaningful Use for Medicaid-eligible providers Modified Stage 2 (applicable for 2017 only) Stage 3 3. Set functional exclusions for the selected provider for the indicated year a. EPCS (Electronically Prescribe Controlled Substances) b. Immunization Registry Reporting c. Syndromic Surveillance Data Reporting d. Specialized Data Registry Reporting e. NAMCS (National Ambulatory Medical Care Survey) Reporting Applicable for MU & QPP/MIPS ACI

14 Measures Setup Each layer within the accordion may be collapsed by clicking or expanded by clicking 4 1. The Quality Measures apply for all programs (QPP and MU) Note: This tab will be populated for all providers regardless of the program selected. a. The Claim Based measures are applicable only for QPP MIPS b. The EHR Based measures are applicable to QPP AAPM and MU, all stages 2. The ACI Measures apply for QPP/MIPS only Note: Measures are defined in 3 sub-categories: Base, Performance, & Bonus. 3. The Improved Activities apply for QPP/MIPS only Note: Select activities qualify for ACI Bonus points also. 4. The Meaningful Use tab applies only for Meaningful Use Core Objectives, all stages Note: For required CQM, please see Quality Measures EHR Based tab.

15 Quality Measures 1. The Reporting Period will be completed for attestation/data submission (Jan. 2018) 2. The 2 tabs are based upon the data submission method (Claims or EHR) Minimum of 6 measures must be selected All measures must be from the same data submission method 3. Use Search By/Filter By options to locate measures by Type, Priority, or Specialty Note: Specify criteria then click the Go button The Measures Details will display all measures within the search/filter criteria entered above, including: Quality ID, Name, Type, High Priority status, applicable Specialties, and an Info link to view the measure specifications/definition.

16 Quality Measures (cont d) 1. Select the check box for each measure to be reported (a will display: ) Note: At least 6 measures should be selected under either tab (but not both). 2. At least 1 measure must be Type: Outcome or relevant High Priority: Yes. 3. Click Info to view the applicable measure s definition and requirements

17 Viewing Measure Specifications ( ) 1. Example of a Claim-based measure, which includes required QDC Codes 2. Example of an EHR-based measure and the requirements of clinical documentation The format/content of this icon will vary for each measure. The requirements is what determines where in PrognoCIS the data is captured. 1 2

18 ACI Measures 1. The Reporting Period will be completed for attestation/data submission (Jan. 2018) 2. Use Search By/Filter By options to locate measures by Base status or Weight. Note: Specify criteria then click the Go button. 3. The Measures Details will display all measures within the search/filter criteria entered above, including the Measure ID and Name as well as whether or not it is Required for the Base Score and its Performance/Bonus Weight A single list includes all 3 sub-categories: Base, Performance, and Bonus. Note: Some measures apply across multiple categories (i.e.: Base/Performance). All Base measures will be pre-selected and identified as Required for Base: Yes Performance measures will display a Performance Score Weight %

19 ACI Measures (cont d) 1. Select the check box for each measure to be reported (a will display: ). Note: All Base measures are pre-selected and cannot be deselected ( ). 2. If reporting at least 1 of the 18 EHR-based Improvement Activities, you must select measure ACI_IACEHRT_1 to receive credit for the bonus points (see IA category below) A Performance Score Weight > 0 indicates either Performance or Bonus measure.

20 Improvement Activities 1. The Reporting Period will be completed for attestation/data submission (Jan. 2018) 2. Use Search By/Filter By options to locate activities by Weight or Related to ACI Bonus. Note: By default, all 92 activities defined by CMS are listed for all categories. 3. The Activity Details section will display (a) all activities within the search/filter criteria entered above, including the Activity ID, Name, Sub Category, Weightage and whether or not it is Related to ACI Measures (i.e.: 1 of the 18 IAs that qualify for ACI Bonus) b 3a 4 4. Click to view the activity s definitions and requirements.

21 Improvement Activities (cont d) 1. Select the check box for each activity to be reported (a will display: ). Note: Select any number of activities worth at least 40 points*. 2. When selecting activities for ACI bonus, be sure to select ACI_IACEHRT_1 above also. 1 *Activity Weightage: Medium = 10 points High = 20 points 2

22 Viewing Activity Specifications ( ) Clicking the Info icon ( ) for any activity invokes that activity s specifications as to what is required within the practice to attest Yes. IA that does not require data to be captured within EHR. It is a requirement outside of PrognoCIS. 1 of the 18 Improvement Activities that also qualify as ACI Bonus when the data is captured within CEHRT.

23 Meaningful Use Core Objectives All objectives for the selected Stage should be selected unless you are excluded. See Appendix B for Core Objectives Select the check box for each applicable measure The required Core Objectives will be pre-selected for the stage indicated above for the selected Provider.

24 QPP/Meaningful Use Reports

25 MU/QPP Reports Reports MU/QPP Reports Classification: 2017 QPP-MIPS See Appendix A QPP MIPS Weightage/Scoring Classification: 2017 MU Reports MIPS-Quality-Claim Report

26 QPP/MU Reports (cont d) 1. Able to generate for multiple Providers at once (tooltip will list all selected names) Patient level filters available 3. Additional filters for QRDA only* *Measure-specific Problems per selected demographics

27 QPP/MU Reports in PrognoCIS (cont d) Classification: Quality-EHR-eCQM-QRDA1 Patient-level details for each specific ecqm measure Classification: Quality-EHR-eCQM-QRDA3 Cumulative/Summary reports for all applicable measures

28 QRDA1 Import Settings Configuration Clinic QRDA1 Import Patients will be matched by First & Last Name, Gender, DOB, & Provider NPI. User Role requires Read Access

29 MIPS Quality Claim Based Reports MIPS-Quality-Claims Report Encounter TOC Quality Measures Note: Formerly labeled as PQRS. G-Code column relabeled as QDC (Quality Data Code) as required on the claim when applicable.

30 MIPS Quality Claim Based (cont d) Encounter TOC Assessment ecqm button 1 1. Encounter-level values for the current/selected encounter (Numerator/Denominator) 2. System-level values for the current Attending Provider s Overall % for that one measure 2

31 Appendix A QPP MIPS Weightage / Scoring

32 Performance Category Weights The weights assigned to each category are based on 1 to 100 points The overall MIPS score is a number of points calculated by the individual scores of each category and weighted to final score of 100 (or 100%) The following example uses random points based on partial participation minimums.

33 Quality Category Scoring Counts for 60% of overall MIPS score CMS-defined Performance Benchmarks classified into deciles Benchmarks are specific to the data submission method and are based on 2015 PQRS reporting data EC will earn from 3 to 10 points per measure (not counting bonus points) based upon performance % within the applicable decile assigned Example 1: EC reports required data and gets a performance score of 5.25% This falls in the 1 st decile, which is worth 3 points Example 2: EC reports required data and gets a performance score of 78.25% This falls in the 10 th decile, which is worth 10 points

34 Quality Category Scoring Example A minimum of 3 points will be given for any amount of data submitted per measure The more data submitted, the higher potential points to be earned Bonus points are earned by submitting additional measures (beyond the 6 required) The Points Measure 1 = 10 pts (Outcome measure) Measure 2 = 6 pts Measure 3 = 8 pts Measure 4 = 9 pts Measure 5 = 10 pts Measure 6 = 10 pts Measure 7 = 1 pt The Score points 60 maximum = Quality = 90 points

35 Improvement Activities Category Scoring Counts for 15% of overall MIPS score Report up to 40 points to receive full credit for this category 92 activities defined under 9 categories Each activity is weighted as Medium or High Medium = 10 points High = 20 points

36 Improvement Activities Scoring Example Example 1 Report 3 activities Weightage: Medium 2 x 10 pts = 20 pts High 1 x 20 pts = 20 pts Example 2 Report 2 activities Weightage: High 2 x 20 pts = 40 pts

37 Improvement Activities Scoring Example (cont d) Counts for 15% of overall MIPS score Report activities that equal up to 40 points Note: 18 of these also qualify towards ACI Bonus points (see ACI Scoring Example below). Example 1 Points IA 1 = 10 pts IA 2 = 10 pts IA 3 = 20 pts The Score 40 points 40 maximum x 100 possible = IA = 100 points

38 Advancing Care Information Category Scoring Counts for 25% of overall MIPS score Score is calculated across 3 sub-categories worth maximum 155 points Base score = 50 points Note: All 5 of these measures are mandatory, or no credit will be issued to the EC for this category at all. Performance score = 90 points Bonus score = 15 points 5 points for reporting 1 Public Health Reporting measures Note: The bonus points apply regardless of one, two, or all three PHR measures being fulfilled. 10 points for reporting any of the specific 18 Improvement Activities within CEHRT

39 ACI Base Scoring Example EC must fulfill the requirements of all five Base Score measures If requirements are not met, EC will get a 0 for overall ACI score* up to 50 points The Points 5 Base measures count as a whole; no point value is assessed to measures individually EC must attest Yes to the 1 st measure (Security Risk Analysis) Numerator must be at least 1 or more for the other four measures *The Score ACI Base = 50 points

40 ACI Performance Scoring Example The Points* Base 3/Perf 1 = 10 pts Base 4/Perf 2 = 10 pts Base 5/Perf 3 = 10 pts Perf 3 = 10 pts Perf 4 = 7 pts Perf 5 = 8 pts Perf 6 = 8 pts Perf 7 = 10 pts Perf 8 = 7 pts Perf 9 = 10 pts The Score ACI Performance = 90 points *Each measure is worth from 1 up to 10 points based on benchmarks set by CMS.

41 ACI Performance Scoring Example (cont d) CMS has established Performance Rates for each measure Most measures are worth a maximum of 10 percentage points Based on numerator/denominator submitted, 1% = 1 performance point The Immunization Registry Reporting measure is actually a Yes/No rather than a numerator/denominator result; thus, EC gets either 10 or 0 points. Note: This measure will also qualify towards Bonus points. up to 90 points Performance Rate per Measure Example: Numerator/Denominator = 90/100 Performance Rate = 90% ACI Performance Score = 9 points

42 ACI Bonus Scoring Example Attesting Yes to 1 or more of the Public Health Reporting measures^ yields the EC a 5% Bonus Attesting Yes to the completion of at least 1 or more of the specific 18 Improvement Activities using CEHRT results in a 10% Bonus up to 15 points The Points The Immunization Registry Reporting Performance measure also counts as a Bonus measure worth 5 points^ Note: Whether you do only the 1, or if you do 2 or all 3 PHR measures, it is only worth 5 Bonus Points. The Score ^ACI Bonus = 5 points

43 Advancing Care Information Scoring The Total The Score Base 50 points + Performance 90 points + Bonus = 5 points = Total ACI = 145 points Maximum Allowed ACI = 100 points

44 MIPS Composite Score The Final MIPS Score is calculated by combining the individual scores from all categories Quality 54 points (90 points x 60%) IA + 15 points (40 points x 15%) + ACI 25 points (100 points x 25%) = Quality IA 100 x 15% = x 60% = ACI 100 x 25% = 25 MIPS score = 94 points

45 MIPS Composite Score (cont d) The Final MIPS Score determines the level of payment adjustment in 2019 for the EC Scores of 70 points or more allow for additional bonus incentive In our example, the score of 94 points qualifies for a positive adjustment + bonus potential due to participation beyond minimal requirements Full Participation Test/Minimal Participation Partial Participation No Participation MIPS score = 94 points

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47 Questions and Answers.