CMS Web Interface Weekly Support Call: Session 2
04
February

By Adem Lewis / in , , , , , , , , , , , , , , , , , /


Hello everyone. Thank you for joining today’s CMS Web Interface
support call. During this webinar, CMS will provide an overview
of 2019 CMS Web Interface quality reporting for MIPS Groups and ACOs, and after the webinar,
CMS will take as many questions as time allows. So now I’ll turn it over to Lisa Marie Gomez
from CMS to begin. Welcome everyone, and thank you for joining
us today as ACOs, MIPS Groups and Virtual Groups prepare to report quality data reporting
via the CMS Web Interface. I am, as you all know, I am CMS subject-matter
expert regarding the CMS Interface. Joining me on today’s call are other CMS subject-matter
experts and contractors who will share helpful information regarding quality data reporting
through the CMS Web Interface, and we’ll answer your questions during the question-and-answer
portion of today’s presentation. I just want to let you know that today’s call
is focused on quality reporting, so if you have any questions regarding Promoting Interoperability,
improvement activities, MIPS, or other general questions regarding quality reporting, you
can contact the Quality Payment Program Service Center. Next slide, please. Before we begin today’s presentation, we will
just note that the information presented in today’s presentation is current at the time
of its publication. Medicare policies change frequently. We encourage you to review and use the source
documents and links that are provided throughout the presentation, and please stay tuned for
any communication from the Quality Payment Program, Medicare Shared Savings Program for
the next generation ACO model regarding any updated information. Next slide, please. As you all know, the submission period for
the CMS Web Interface aligns with other submission types for the 2019 performance year, which
opened on January 2nd, 2020, and will close at 8:00 p.m. Eastern Daylight Time on March
31st, 2020. Once the submission period closes, the CMS
Web Interface will automatically accept your submission. As a reminder, the CMS Web
Interface is accessible using the “Sign in” link on the Quality Payment Program website. Next slide, please. As you know, today is part of a series of
CMS Web Interface Support Calls, held weekly through the data submission period. The next report call will be held next Wednesday,
January 29th, 2020, from 1:00 to 2:00 p.m. Eastern Standard Time. Topics will include high priority and end-to-end
bonus points, frequently asked measure questions covering the following measures, CARE-2 and
MH-1, PREV-5, PREV-6, PREV-12, and PREV-13. Additional topics will be added prior to the
support calls if we need to add any. Next slide, please. The Other CMS Approved Reason skip requests
must be submitted through the CMS Web Interface. This is a way to skip a patient attributed
to a measure during denominator confirmation. The CMS-approved reason is 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. Next slide, please. The 2019 CMS Web Interface API is available
all year for testing in the developer preview environment. You can review the resources listed on this
slide for more information. Next slide, please. Now I’m going to turn the presentation to
Kara to discuss the assignment and sampling FAQs. Kara. Thank you. The common question is, what if prepopulated
demographic information is not correct? While it is not anticipated that ACOs, MIPS
groups, or virtual groups will have a need to modify the prepopulated demographic information,
it is an option. If the beneficiary’s demographic information
in the record and in the CMS Web Interface does not match, then the CMS Web Interface
user may need to correct the information. For example, Medicare claims may not have
the accurate date of birth for a beneficiary, in which case the Web Interface user should
correct this information, because it may affect that beneficiary’s denominator eligibility
for certain measures. Note that if those updates do not get recorded
back to the Medicare beneficiary enrollment database, you should encourage your patient
to contact the Social Security Administration directly to update their demographic information. Thank you. You can proceed to the next slide. Next, we have Lisa Marie Gomez for an update
on PREV-12. Thank you, Kara. So, now, as Kara noted, I’m going to discuss
PREV-12 scoring updates. So, next slide, please. Okay, so during last week’s support call we
indicated that CMS is changing how the PREV-12 measure, specifically the prevention, care,
and screening, screening for depression follow-up measure, is scored. Right now, we’re going go over the scoring
changes again to ensure that all ACOs and groups recording through the CMS Web Interface
are aware of the scoring changes. For the 2019 performance year, the following
will apply: for the Medicare Shared Savings Program and the Next Generation ACO Model,
we are changing the measure from pay-for-performance to pay-for-reporting. And for purposes of MIPS, the measure will
be excluded from scoring. It should be noted that ACOs and groups will
still need to meet reporting requirements for PREV-12, even though the measure has been
changed to pap-for-reporting for the Medicare Shared Savings Program and the Next Generation
ACO model, and for purposes of MIPS excluded from scoring. Also, I would like to note that for the purpose
of performance year 2019 CMS Web Interface reporting, CMS will accept any of the follow-up
plan actions previously allowed in the 2018 measure specifications, including repeat screenings
after initial positive screens. Next slide, please. Now I will turn the presentation to Angie
Stevenson. Hi everyone, this is Angie. We have some frequently asked questions we’d
like to share with you that are received at the QPP Service Center. The next slide, please. Make sure you’re there. Okay. It’s for the DM-2 measure and the question
is, if we have a lab result that shows a collection date and a result date – for example, the
collection date is maybe November 1st, and the result is November 5th – which date would
we use to report the results in order for the measure to be compliant? Based on the measure specifications, it’s
appropriate to provide the date the blood was drawn as your first choice. You would use the following priority ranking:
lab report draw date, lab report date, flow sheet documentation, practitioner notes, and
then other documentation, and this is detailed out in the measure specifications for you. Next slide, please. This question is for Hypertension: Controlling
High Blood Pressure. Are the blood pressure readings from an inpatient
setting, emergency department, or urgent care acceptable? Yes. Although the measure is intended to be outpatient,
blood pressure readings from any clinical setting are acceptable when reporting the
numerator. It would be appropriate to move to the next
most-recent blood pressure if the most recent blood pressure from an inpatient setting,
ED, or urgent care is not within normal parameters. Question two is, does the blood pressure reading
have to be from the most recent visit in the measurement year? The answer to that is no. Performance is based on the most recent blood
pressure documented in the patient’s medical record during the measurement year, so, the
most recent blood pressure may or may not be found within the most recent visit. Next slide, please. These are questions for the PREV-7: Influenza
Immunization Measure. Question one, the code 90689 for the IIV4
influenza virus vaccine for intramuscular use code was new October 1st, 2018, and is
not included in the 2019 PREV Coding document. Is this vaccine acceptable to meet the measure? IIV4 vaccines are not excluded in the measure
specifications. The Numerator Codes in the 2019 PREV Coding
document are all inclusive for the purpose of mapping from the EHR. But if there’s medical record documentation
showing the patient received an IIV during the appropriate timeframe, it is acceptable. Question two is, 2019 Influenza Immunization
specs still state that LAIV vaccinations are not eligible for the numerator. The CDC approved the LAIV vaccination for
the 2018-2019 flu season. Given the fact that the CDC approved this
vaccination, again, will these immunizations be considered numerator compliant for the
2019 reporting year? Per CMS direction, if a patient receives the
live attenuated influenza vaccine, LAIV, for the 20182019 flu season, you should report
a Denominator Exception for System Reasons. Next slide, please. Question three is, does there need to be documentation
that the patient met the denominator exception criteria during the flu season, being August
1st, 2018, through March 31st, 2019? The answer is, for 2019, the documentation
should be during the measurement period and be specific to the flu season being reported
unless it is for documentation of a medical reason for not receiving the influenza vaccine
due to an egg allergy. A documented history of an egg allergy in
the patient’s medical record is acceptable for this exception. However, we wanted to let you know that beginning
in 2020, documentation of the egg allergy must be during the measurement period and
be specific to the flu season being reported to ensure that the allergy is still active. So, a documented history of an egg allergy
in the medical record will no longer be accepted. This guidance aligns with the measure steward’s
intent for using the Denominator Exception for Medical Reason. So, we did receive classification from them
for 2020. Next slide, please. These questions are for the PREV-10: Tobacco
Use Screening and Cessation Intervention measure. Question one is, does a screening done in
the Emergency Department or inpatient count? The answer is, yes. The setting is not specified for this measure. You must use the encounter where the most
recent tobacco user status was documented. Question two, what if the patient is screened
and is a smoker but is screened again at a later date and is considered a non-smoker? If there is more than one patient query regarding
tobacco use, the most recent during the 24-month look-back period from the measurement period
end date, which is January 1st, 2018, through December 31st, 2019. In this scenario, the patient would be considered
a non-smoker for the purposes of the measure. Question three, is there a specific length
of time that a patient has to be a non-smoker for them to be considered not a current tobacco
user? No. There is no specific length of time that must
pass after a patient ceases using tobacco in which they may be considered a non-smoker. Next slide, please. Question four, what medications are acceptable
for tobacco cessation? The
Numerator Drug Codes in the 2019 PREV Coding Document may be referenced for a listing of
appropriate medications. These codes are all-inclusive for the purpose
of the EHR mapping; however, medical record documentation can be used if the patient meets
the intent measure. Both the brand name and the generic versions
of the drugs in the coding document are acceptable. Question five, who is able to complete the
cessation intervention within our organization? For example, can a medical assistant provide
counseling to the patient or does it need to be a physician? Cessation counseling can be provided by anyone
your organization considers qualified and for whom the eligible clinician or group takes
responsibility for. Per the measure specifications, in order to
promote a team-based approach to patient care, the tobacco cessation intervention can be
performed by another healthcare provider; therefore, the tobacco use screening and tobacco
cessation intervention do not need to be performed by the same provider or clinician. Thank you very much, and I will turn it back
over to Lisa Marie Gomez with CMS. Thanks, Angie. So, the next few slides will outline the available
CMS Web Interface resources. So, next slide. So, right now we’re on slide 19, so please
note that 2019 materials providing information on the MIPS Quality performance category are
available on the Quality Payment Program Resource Library. We encourage reviewing these resources if
you have any questions on Quality requirements and measures. We’ll continue to communicate any future postings
and upcoming support calls. Next slide, please. The QPP Webinar Library also contains recordings,
slides, and transcripts of past QPP webinars, including the recent 2019 CMS Web Interface
User Demonstration held in November, and CMS Web Interface Kickoff Call held last December,
and, also last week’s support call. Please note that it does take about one to
two weeks to post the presentation to the library following a webinar, so we just want
to highlight that, you know, as we have these support calls, please check regularly so you
can see which ones are posted. So, if you need to go back to any information
that we discussed in previous slide decks, you will have access to that information. Additionally, the Help and Support Page on
the QPP website contains links to materials such as videos, webinars, and online courses,
as well as other items to help with reporting and development. Next slide, please. This slide contains links to resources available
for the Medicare Shared Savings Program ACOs and the Next Generation ACO Model. We encourage you to review the materials available
here and sign up to each newsletter for more information. Next slide, please. If you need additional assistance, please
refer to the contact information listed on this slide. Next slide. Now, just before we go into the Q&A portion
of the support call, if you’re interested in providing feedback and collaborating with
CMS on the Quality Payment Program, we encourage you to participate in our Human-centered Design
efforts. To get involved, please email your name, topic,
title, interest, and organization to [email protected] Now I will turn this portion of the presentation/support
call to Mikala to begin the Q&A session. Great. Thank you, Lisa Marie. So, now we will begin the question-and-answer
portion of the webinar, so please do submit your questions via the “Questions” tab on
your screen, or you may raise your hand for a phone question, and we will unmute your
line. So, our first chat question is on PREV-5. It asks, if a patient had a unilateral mastectomy
and, therefore, a unilateral mammogram would that count or is a bilateral mammogram required? Hi. This is Angie from PIMMS. Yes, that would be acceptable as long as there’s
medical record documentation that the patient had a unilateral mastectomy and a mammogram
of the remaining breast. Thank you. Thanks, Angie. So, this next question’s on PREV-10. Is lung cancer an exception for why no screening
was done? Hi. This is Jamie with PIMMS. Thanks for the question. I went ahead and took a look at the specifications,
and it indicates for denominator exception of medical reason, that the patient would
have to have a limited life expectancy or other medical reason. So, I went ahead and pulled up the coding
document that is associated with PREV-10, and it looks like the codes are lending themselves
to that terminal illness. So, therefore, my response will be maybe take
another look at that medical chart and see if that patient with lung cancer is a terminal
patient in order to meet the denominator exception. Thank you. Thank you. Our next question says, for the diabetes measure,
it states greater than 9, so A1cs of 9 or less would not meet this measure correct? A1c 9.1 and greater would meet the measure? This is Deb from the PIMMS team, and that
is a correct interpretation of DM2, as shown on Page 5 of the specifications. Just please note that this measure is considered
an inverse measure, so, actually, the lower your performance the better you have done. Thank you. Thank you. All right, we will take a phone question,
so Jason Shropshire, I have unmuted your line. Please go ahead. Hi. Can you hear me? Yes. So, I was hoping to get clarification regarding
PREV-12 measure today. I didn’t see anything about this. So, what we need clarification on is regarding
the screening portion. When a patient scores a PHQ-2 or PHQ-9 of
zero, does the provider have to review anything to satisfy the screening portion? Last year, we were told they did not. This year, there seems to be confusion on
whether or not scores of zero have to be quote, unquote, interpreted by the provider. Please clarify. Kayte, would you be able to address that question? Go ahead, Kayte. Kayte, are you there? You might be on mute. Yeah, Lisa Marie, this is Deb. I think we need to go back and look at those
slides. And, Jason, I know that you need clarification
here. We just want to make sure that we provide
an absolute accurate answer for 2019, as we know that there are some different things
going on for 2019 and 2020, so we will ensure that we can get you an answer today on this
call, if at all possible. Okay. That would be great, because we’ve deliberately
been waiting to run those reports. We’re in a holding pattern, as I’m sure other
people are, until we get that clarification. Yes, sir, completely understand, and I think
we’re going to be able to answer it. But I hope you understand, we want to make
sure that we don’t come out and say something that we should not. So, we’re going to do a quick double check,
take some of the other answers and see if we can get you that answer today. Great. Thank you. All right, so our next chat question is on
PREV-13. Should the diagnosis of hyperlipidemia be
used in lieu of pure or familial hypercholesterolemia? And this is Deb again. And for PREV-13, if you were to look at page
7 of the post of specification, it does define the denominator population for risk category
two, and so you would have to have what is considered an active diagnosis of familial
or pure hypercholesterolemia or have been previously diagnosed with one of those two
conditions. So, simply having the diagnosis, as you indicated,
would not be sufficient confirmed diagnosis for risk population two. Thank you. All right, thank you. Our next question is on HTN-2. Can we use a blood pressure reading taken
from the ED setting? Hi. This is Kayte from the PIMMS team. So, while the intent of the measure is to
the outpatient, blood pressure readings from any clinical setting are acceptable when reporting
the numerators. So, it would be appropriate to move to the
next most recent blood pressure if the most recent blood pressure from an ED or in-patient
setting is not within normal parameters. Thank you. Great. Thank you. And now we’ll take another phone question. So, Brandi Dunn, I’ve unmuted your line. You may go ahead. Hi, Brandi Dunn, are you there? We’ve unmuted your line. You may ask your question. Hi. Can you hear me now? Yes. Hello. Hello. We can hear you. Okay. Great. Sorry. Okay. For PREV-12, any score above a zero, we will
initiate the remaining questions of the PHQ-9 and it’s considered positive, and we’ll do
a pre-in. Does the word “positive” have to be written
out anywhere in the chart or can we just go with the assumption that anything above a
zero, we will continue with the question for the PHQ-9? So, unfortunately, this is the same kind of
thing we need to look into as the question that Jason asked on PREV-12. We need to confirm exactly what we can do
with PREV-12 outside of scoring. So, if you don’t mind, I know it’s a lot to
ask, but if you could just hold that question, we’re going to continue to research and see
if we can get you an answer still on this call. Thank you. Okay, thanks. Thanks. So, our next chat question, this person is
just asking if, Lisa Marie, if you could repeat that last comment you had on PREV-12 that
was mentioned on slide 10 but is not on this slide. Sure. So, I believe that the individual is probably
wanting to repeat information on as to what is the critical action acceptable for reporting. So, as I noted for the 2019 reporting, so
CMS, we will accept any of the follow-up plan actions previously allowed in the 2018 measure
specifications, which includes repeat screening after the initial positive screen. Great. Thank you. So, our next question is on the HTN measure. Are the codes listed on the denominator code
lists the only codes that are counted? And this person notes that they have a PT
that was coded for essential HTN result in 2018 and coded with a different code that’s
not part of the HTN denominator list. Would this patient be not confirmed diagnosis? Hi. This is Kayte from the PIMMS team. So, for this measure, to confirm the patient
in the denominator, you should first ensure that their diagnosis truly did not end prior
to the measurement period. For purposes the mapping to in EHR the codes
are considered all inclusive, but if you’re not mapping and you have medical record documentation
that supports an appropriate diagnosis of essential hypertension within the first six
months of the measurement period, or any time after, and, again, does not resolve before
the start of the measurement period, you can go ahead and use that documentation. Thank you. Thank you. All right, we will move on with another phone
question. So, Meredith Titterington, I have unmuted
your line. You may go ahead. Hi. Can you hear me? Yes. So, my question is about PREV-12. In previous years if a patient had done a
PHQ-2 and that was positive, you could screen for — you could further evaluate their depression
using an additional screening tool. Is that still the case, like a positive PHQ
and then doing a PHQ-9 and it’s negative? Hi. This is Kayte from the PIMMS team. So, as Lisa Marie just mentioned, we are going
to go ahead and accept what was previously allowed for 2018 and 2019. So, for 2019, we will allow any follow-up
depression screen after a positive PHQ-2. Thank you. All right. Thank you. All right. So, our next chat question is asking if the
updated measure specification has been released on the QPP Resource Library? Hi. This is Jamie with the PIMMS. The most current Web Interface specifications
are located on the QPP Resource Library page. If this question is in relation to the 2020
specifications, those, too, are also available on that resource page. Thank you so much. Thank you. All right. So, our next question asks, can tobacco counseling
occur any time during the 24-month look-back period? Hi. This is Jamie with the PIMMS team. Yes, indeed, the tobacco cessation counseling
can occur 24 months as a look-back; that is true. Thank you. Great. Thank you. So, we’ll take another phone question at this
time. So, Darin Barnes, I’ve unmuted your line. If you still have a question, you may go ahead. This question is actually about the Web Interface
Reporting Tool. I was looking through it today, and on PREV-13,
when we’re trying to enter my information, if I have a denominator exclusion such as
end-stage renal disease, you know when you go to the first question, does the patient
have a diagnosis of atherosclerotic cardiovascular disease, and the dropdown selections, and
if I select denominator exclusions, no denominator exclusion, previous years I’m pretty sure
it greyed out everything after that. You didn’t have to continue and answer all
the questions. It looks like this year those questions are
still open. Do I have to — if I have an exclusion, a
major exclusion, do I have to continue to answer all the questions across the board
there? Ozlem, would your team be able to address
that question? Could you please repeat the question? PREV-13, if I have a denominator exclusion,
under the first question of asking if they have ASCVD and I answered, no – denominator
exclusion, because they have end-stage renal disease, in previous years, I’m pretty sure
all the other questions about LDL greater than 90, diabetes, all of that was greyed
out because you have a denominator exclusion. This year, it looks like all of those remain
open. If I have a denominator exclusion, do I have
to continue to enter information in all of those other columns, even though the whole
patient would be excluded? Hey, this is Laura with the Web Interface
Product Team. No, the denominator exclusion should automatically
skip your patient. If you are running into this issue, you could
submit a Help Desk ticket for us with a screenshot of what you’re seeing so we can look into
it further. Okay. I just know they’re not greyed out this year,
and last year I believe they were. Okay. This is Deb from the PIMMS team. I don’t know that this will make a big difference,
but it’s just the verbiage. The ESRD is considered a denominator exception,
which would be treated differently than a denominator exclusion, so just keep that in
mind as you’re looking at the exclusions versus the exceptions. You’re right. I apologize for my miswording. So, I see nowhere there’s a dropdown to claim
an exception. I mean, I’m either missing it or I just don’t
see it. Right. And I think that has to do with the way that
those two different things work. With the exclusion, that patient just is not
eligible for the measure as a whole, and they would be skipped and replaced. When you select an exception, it is always
possible that the quality action has been met, so there could be the fact that you have
a patient who is ESRD, but, for whatever reason, their clinician has determined that they should
still be receiving a statin, and so that would be a performance met. So, it could be that you have to work your
way all the way through that specification, through those risk categories, in order to
determine, at that point, if you should select the exception, again, working different than
the exclusion does. I understand. And I’m only speaking from the measure perspective,
not from the tool, so what you receive from the previous panelists would be accurate for
the tool, and so if you need to send something in for them to look at, I would do that. I just wanted to give that from the measure
perspective. I appreciate that, and I see that now as I
look across. Thank you. Alright. So, our next chat question asks, what is the
positive PHQ-2. Hi. This is Kayte from the PIMMS Team. So, a positive PHQ-2 would be a PHQ-2 score
where the patient was identified as positive for depression. The measure specifications don’t include instructions
on how to determine whether a standardized screening is positive or negative. For that, you would need to refer to the specific
tool in use. Thank you. Thank you. Our next question says, for PREV-6, if the
patient receives an FOBT exam within the measurement period done in the office setting but wasn’t
completed via digital rectal exam, would that satisfy the measure? And they’re asking to please clarify that. Hi. This is Angie with PIMMS. Yes, as long as the FOBT is not collected
via digital rectal exam, it would count. Samples collected via DRE, regardless of setting,
are not approved for the measure. Thank you. Thank you. All right. Our next chat question asks about the flu
vaccine. They say, we have information entered into
the field that were not answered yet. Was this prepopulated by CMS as it was in
previous years? This is Kristin, and, yes, PREV-7 is the only
instance where numerator specific data are prepopulated. But just note that the data is not prepopulated
for all beneficiaries ranked in PREV-7, but only those where immunization can be found
in the claims data. Great. Thank you. And we will take another phone question at
this time, so, Martin Genz, I have unmuted your line. You may go ahead with your question. Hi. I was wondering if somebody could please clarify
which measures this year are pay-for-reporting. Hi. This is Jamie with PIMMS. Thanks for that question. PREV-10 and PREV-12 are going to be for the
ACO side pay for reporting, and then excluded from scoring on the MIPS side. And I just want to make sure that others were
thinking the way that I am, so CMS does that ring true with you? Hi, Jamie. Yes, you’re correct, that for PREV-10 and
PREV-12, for performance year 2019, those two measures are pay-for-reporting for Medicare
Shared Savings Program and Next Gen ECO model, and excluded from MIPS for scoring purposes. This is Saritha. For the Shared Savings Program, you are asking,
as an ACO, because there are other measures as well within the ACO program that are pay-for-reporting
2019? Yeah. MH-1 and staffing measure are both pay-for-reporting
as well, they’re pay-for-reporting all years under the shared savings program, along with
the other two measures that were mentioned. And actually, did I miss any other measures
that are pay for recording on the Shared Savings Program for 2019? No. I think you covered it Saritha. You said MH-1 and what else? The statin measure, which is PREV-13, I believe,
if somebody could correct me on that one. That’s correct. Yeah. And it’s ACO 42 Shared Savings Program. As an ACO, are you an ACO in your first performance
year of your first agreement for ACO? ACO, and we have five ACOs under us this year. Is this your first performance year of your
first agreement period? No. Okay. Then those are the only measures will be paid
for reporting for year 2019. Great. Thank you. You’re welcome. Great. Thank you. So, our next chat question says, for the diabetes
measure, if the physician’s note said that recent A1c is 6.4 according to the patient,
but there is no date for the A1c, can we take it? And this is Deb. No, you would not be able to take that value,
because you need to be able to confirm that the A1c is an A1c that occurred during the
measurement period. Thank you. Thank you. All right, our next chat question is on PREV-10. If the medical record has an office note including
social HO tobacco use never reviewed, does the record qualify the patient for the measure? Hi. This is Jamie with PIMMS. Thanks for asking this question. Just taking a look at it, looking at the measure
specification, and I will be honest with you, I’m not sure what “never reviewed,” what that
really means within your system. And I believe you’re trying to confirm this
patient based on that screening ask back as to whether or not they’ve been screened for
tobacco. So, just a couple thoughts here, either try
to clarify the question within the Q box or go ahead and submit a question to service
now, and we’ll be able to get the proper response that you need to continue with this patient
for abstraction. Thanks so much. All right, our next question asks, what exactly
does re-screening mean as part of a follow up for PREV-12? Hi. This is Kayte from the PIMMS team. So, in previous years, it was acceptable to
conduct another standardized depression screen after receiving a positive standardized depression
screen. So, that initial screen is followed by an
additional screening. In 2019, there were some coding changes made
that removed the associated follow-up screening. However, CMS has given guidance that, for
2019, they will allow and accept any follow-up actions previously allowed in the 2018 measure
specification. So, a repeat screen on additional standardized
depression screening tool after an initial positive screen will be accepted for 2019
reporting. Thank you. Great. Thank you. So, for this next question this person is
looking for some clarification on tobacco cessation counseling. They note that in the past, the counseling
— I’m sorry, I just lost this question. In the past, the counseling has to be completed
by an eligible licensed clinician. And based on today’s presentation, is it appropriate
for a medical assistant to offer the cessation counseling at the time a patient is screened
as a tobacco user? Hi. This is Jamie with the PIMMS team, and you
got me scrolling through the specification right now. I wasn’t quite ready for you. But that’s okay. I know it’s in the guidance of the documentation
within that specification, it does speak to this measure, having a clinical team approach. In that instance, they do allow for other
medical clinicians to go ahead and do that tobacco screening and that cessation. So, in this instance, that would be appropriate. Thanks for the question. Thank you. All right, we’ll take another phone question
at this time. So, Drew White, I have unmuted your line. You may go ahead with your question. My question is, once a minimum is met for
each measure, and let’s take examples of fall risk assessment, once the minimum is met,
is it true that each patient that is met — let’s say met at patient number 350, that every
patient after that, where the patient is compliant, where the measure has been met, that it will
add to your score and then once you reach patients who are not compliant, that that
will take away from your score? In other words, if you met the fall measure
at number 350, and the next five patients are compliant, then you would continue to
report the next five patients; is that correct? Hi. Once you meet the minimum reporting requirements,
which is 248 beneficiaries, you will finish reporting for that measure. If you skip a patient ranked within the minimum
248, that patient will be skipped, and then you will need to move on to the next ranked
beneficiary, ranked number 249, and report on that beneficiary to complete your minimum
reporting requirements. Once you meet your minimum reporting requirement,
you are not required to complete any of the beneficiaries and the over sample. However, if you choose to, you can complete
the beneficiaries in the over sample, and the beneficiaries in the over sample, if completed,
will impact your score. I hope this answers your question. Yes, it does. Thank you. All right. Thank you. So, going to our next chat question, just
one moment while I pull this next one up. So, this next one is on PREV-5 and PREV-6,
and the person would like to confirm how patient denials should be documented within the interface. Is written confirmation of a denial numerator
compliant? Hi this is Angie from PIMMS. There are no denominator exceptions for patient
refusal for the breast cancer or the colorectal cancer screening measures, so you would select,
no, when reporting the numerator for those. Thank you. Thank you. All right, this next question is for PREV-12. Can we use only PHQ-9 as a screening tool? Hi. This is Kayte. So, for PREV-12, PHQ-9 is not the only screening
tool available. There’s a list of appropriate screening tools
for that standardized depression screening that starts on page 5 of the 2019 CMS Web
Interface webinar specifications. Thank you. Thank you. All right, and then I do want to revisit one
question. This person said they didn’t quite understand
the response, so back to this question on the HTN measure. Are the codes listed on the denominator code
lists the only codes that are counted? I have a patient that was coded for essential
HTN, resolved in 2018, and coded with a different code that is on the HTN denominator list. Would this patient be not confirmed diagnosis? So, this is Kayte again. This question has many facets, and if this
response does not cover the whole gambit, I would urge the submitter to submit their
question to [email protected] But, for purposes of the denominator confirmation,
the patient has to have a documented diagnosis of essential hypertension within the first
six months of the measurement period, or any time prior to the measurement period: but
that diagnosis cannot end before the start of the measurement period. So, the codes that are listed in the coding
document are considered all-inclusive for purposes of mapping to an EHR. However, if you have had medical record documentation
of the appropriate diagnosis, and that it is active within the first six months, or
any time prior to the measurement period and has not ended, you can use that documentation
and confirm that diagnosis for the measure. Thank you. Great. Thanks, Kayte. So, this next question is on the PREV-10 numerator
drug code. Will another strength or form of that drug
listed be accepted; for example, Nortriptyline 10-milligram oral tablet? That’s a tongue twister. That was good. Yeah, thanks for this question. This is Jamie with PIMMS. Yeah, that’s acceptable, just ensure that
you have the documentation within the patient’s medical record. Thank you. Great. Thank you. All right, we’ll take another phone question
at this time. So, Morgan Keene, I’ve unmuted your line. You may go ahead with your question. Hey, my question is regarding PREV-13. We’re working through, you know, the different
risk category populations, and we noticed, obviously, it’s quicker for us to find diabetes
first, so we wanted to understand is it okay to jump to risk population number three first
to address the questions? This is Deb from the PIMMS team, and I’ll
answer from the perspective of the measure. And I don’t know if anyone else on the call,
any of the other panelists, would have additional information that they would like to share. But the way we understand this measure from
the measure steward is that you should be working through the risk categories in order
that they have been included in the specification. So, you really should be going through the
risk categories, starting with risk category one. Again, I don’t know if any other panelists
on the call have additional information. I mean, maybe there’s a way in the tool that
it’s working differently, so keep in mind that this is strictly from the measure perspective. Hi. This is Laura from the Product Team as well,
and, yeah, you’ll need to answer the questions in order. It’s kind of hard with the conditional formatting
that we have with our questions to answer that out of order. Okay. Thank you. Great. So, our next question is asking, is there
somewhere where I can find any additional information on the PREV-12 changes and/or
clarification? Hi. This is Jamie with PIMMS. This is a great question, and I’m going to
look to maybe CMS to beef up my answer a little bit. I will go ahead and look into, potentially,
providing more information to support submission of this measure in regards to getting you
the answers that you need. As Deb indicated earlier on the call, any
questions that you do have subsequent from the information received today, I would, you
know, kindly ask you to continue to submit your service now, inquiries and we can go
ahead and get those answered and provide as much detail as possible on how to get this
submitted. Lisa Marie, or any others, any additional
information you can provide in regards to this topic? So, no, Jamie, I think you answered it, and
I think I know we’re getting look a lot of questions about this, and this, I think, is
a large topic, particularly because we’ve been holding off on discussing this. But, as we get through these questions, we
are trying to answer as much as we can and provide you with the information to help you
build the report. So, I don’t have anything further to add. But I think right now we’ll continue to address
your questions that come in, and also, just so you know, please submit your questions
also via the Quality Payment Program Service Center, and we also address your questions
there. And, as you know, we have a support call next
week, so please continue to submit your questions during that time. And as we continue to go through the various
dynamics with these questions we have today, we will also continue to direct those, hopefully,
next week, via the frequently-asked-question portion for next week. Great. Thank you. So, this next question is on HTN. If the patient’s recent blood pressure reading
is high at the ED visit but the office visit blood pressure reading is normal prior to
the ED visit, which one can we take? Hi. This is Kayte from the PIMMS Team. So, in this instance, if the most recent blood
pressure from an ED or in-patient setting is not within normal parameter, it would be
appropriate to move to the next most recent. So, again, although this measure is intended
to be outpatient, those blood pressure readings from other clinical settings can be used. But if they are — excuse me, not within normal
parameters, in this instance, it would be acceptable to use the next most recent. And to reiterate, that’s only for ED or inpatient
settings. For outpatient settings, you would need to
use the most recent blood pressure. Thank you. Thank you. All right, it looks like we have time for
one more question. So, our last question is on the PREV-7 influenza
measure. If we see our patient had the vaccine administered
via our state’s immunization registry but we do not have documentation in our EHR, would
we count this patient as compliant? This is Deb. Go ahead. Oh, go ahead, Deb. Go. As long as you can find and you have medical
record documentation that the influenza measure has been met, you can certainly use it. Just be aware, you know, in the event of an
audit, you would have to be able to show documentation that supports what you’ve reported. So, you would want to be able to show that
the patient received an influenza vaccination during the appropriate time period in order
to show that the measure has been met. Great. Thank you. So, that is all the time that we have for
the Q&A today, so, as Lisa Marie said, of course we will have our next weekly support
call next Wednesday at 1 p.m. Eastern Time, and those will go on weekly until March 25th,
so thank you all for joining, and I’ll pass it back to Lisa Marie for final closing. Thank you, Mikala. I just want to thank you all for joining us
today. This slide deck, the recording, and the transcript
from today’s call will be available on the QPP Webinar Library in the next two weeks. It takes about two weeks to post these materials,
so just keep an eye out for those every two weeks, once the presentation is concluded. As Mikala noted, our next support call is
next week from 1:00 to 2:00 p.m. Eastern Standard Time, and the topic that we will cover next
week will be the High Priority and End-toEnd Bonus Points and Frequently Asked Measure
Questions Regarding Quality Measures, which are CARE-2 NH- 1, PREV-5, PREV-6, PREV-12,
and PREV-13. We hope you all can join us. Thank you again and have a good day.


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