Thank you. This is just our standard disclaimer, and you can review this at your leisure. Next slide, please.

Transcription

1 Hello, everyone. Thank you for joining today's Web Interface Support Webinar. This series of webinars is for Accountable Care Organizations (ACOs) and groups that are reporting data for the Quality performance category of the Quality Payment Program through the CMS Web Interface for the 2018 performance period. These webinars will highlight important information and updates about reporting quality data and provide ACOs and groups with the opportunity to ask CMS subject-matter experts their questions. During today's webinar, we also shared links to various resources and other information that will appear as announcements on your screen. Please note that these calls will only focus on reporting data for the Quality performance category. We will not cover reporting data for the other performance categories during these calls. Now I will turn the call over to Susan Pierce-Richards from the Center for Medicare and Medicaid Innovation at CMS. Please go ahead. Thank you. And welcome and good afternoon. This is the 2018 CMS Web Interface Quality Reporting for MIPS Groups and ACOs Web Interface Q&A session for February 20, Next slide. Next slide, please. Thank you. This is just our standard disclaimer, and you can review this at your leisure. Next slide, please. This is just a reminder that the Web Interface submission period is obviously open, but it will close promptly at 8:00 p.m. on Friday, March 22, If you have any accessibility issues, please use the QPP Help Desk. We'll give you a link to that at the end of the session. Next slide, please. This slide just reviews the reminder about a CMS Approved Reason, and this is a way to skip a patient attributed to a measure during the confirmation. This slide provides an overview of the circumstances and the process for submitting requests for CMS Approved Reasons. What's very important is that requests need to be submitted by March 15, 2019, because any submissions after this date are unlikely to be processed. Next slide. This is another reminder slide, also about the CMS Approved Reason, and this just reviews the specific information that submitters must include when putting in a CMS Approved Reason Request. Remember to never include personally identifiable information or protected health information in the request. Next slide. We will continue the weekly webinar support through March 20th. The links to the flyer are here. Next slide. And I will now turn this over to Angela for some review and some frequent measure questions. Thank you. Hi. This is Angela Stevenson, with the PIMMS Measures team, and we're going to review some of the frequently asked questions that we've received at the QPP recently. Next slide, please. Starting with the CARE 1: Medication Reconciliation Post-Discharge measure. Question 1 is, "Does documentation need to say 'discharge medication'?" And not necessarily, but it is dependent upon a number of factors, including internal policies and procedures, EMR setup, et cetera. The discharge medications must be reconciled with the most recent medication list in the outpatient record, and the documentation must support the action reported. You can see the list of acceptable criteria on page 5 of the measures specifications, and it will give you the different examples of what needs to be included. For question 2, "Does the outpatient medical record need to 1

2 also note the discharge date?" No, it does not. Any medical record documentation may be used to confirm the discharge data, as long as it is available at the point of care. This information must be available in the event of an audit. We have questions 3 and 4. 3 is, "If a patient was discharged to a skilled nursing facility for 30 plus days, what do we do?" The other is, "If the only encounter we see after the discharge date is an ED visit, does that count?" So, in either situation, if the patient was not considered inpatient during that visit that occurred within 30 days of the prefilled inpatient discharge date, then the patient may be included in the denominator. Next slide, please. This question is regarding the PREV-10: Tobacco Use: Screening and Cessation Intervention. I believe it may have been similar to questions we received last week, and we wanted to clarify. "If the patient is a tobacco user and we provide education, such as referrals to coaching or other services to help quit smoking, will this count as counseling?" Providing literature alone without counseling does not meet the intent of the measure. The intent is for the provider to directly address the patient's tobacco use in response to the most-recent positive screening. There must be documentation that some type of discussion took place, and part of that discussion may include giving educational materials or referral to services to help quit. Next slide, please. These questions are regarding the PREV-12: Screening for Depression and Follow-up Plan measure. Question 1 is, "Can we exclude patients who have dementia or Alzheimer's Disease?" The denominator exception should only be claimed if there is medical-record documentation stating that the depression screening was not performed due to the progression of their disease. Question two, "Can we exclude a patient who has a diagnosis of bipolar?" And the patient may be excluded if there is an active diagnosis of depression or bipolar prior to the encounter with the most recent depression screening, which is your numerator event. And thank you, everyone. That concludes the frequently asked questions. I'll turn it back over to Susan. Thank you. And here we will just briefly go over some of the resources available to you. Next slide, please. This slide contains links to some documents on the QPP Resource Library, and this has information on the Web Interface, as well as measure-specific guidance documents. Next slide. The QPP Resource Library also contains a number of recorded instructional videos and links to the QPP Help Desk in case you need that. Next slide. The QPP Resource Library also contains recordings of these webinars, as well as the initial kickoff and user-demonstration webinars, and we are adding to those as they are ready to be published. Next slide. If you need information that's specific to your respective ACOs, you will find links here. Next slide. And, again, if you need assistance, here are some links. If you need some help from either the QPP or Medicare Shared Savings or NG ACO-specific information. And I will turn it back over for the Q&A. Thank you. 2

3 Great. Thank you. We are now going to start the Q&A portion of the webinar. You can ask questions via chat or via the phone. To ask a question via phone, please dial And if prompted, provide the conference I.D. number, which is , and press star-1 to be added to the question queue. And if you do have any follow-up questions or clarification that you'd like to share during this portion of the webinar in the chat, please type "follow-up question" at the beginning of your chat question so that you can flag that for us. All right. So, our first chat question is on PREV-12, and the person says that some of their office has a clinical protocol that utilizes the PHQ-2 for screening patients. They say that the PHQ-2 is automatically scored and then a PHQ-9 is served up to the patient as clinically designed by the protocol, and both tests are reviewed by the provider and documentation of the test results are in the EMR, and, in some cases, the test itself is in the EMR. And the test results are reviewed as a part of the visit by the provider, and then the visit is signed by the provider. Does this meet the measure? This is Deb from the PIMMS team. Yes, it does if the initial screening is considered positive and the recommendation is to follow up with additional screening. So, in this case, you're going from the PHQ-2 to the PHQ-9. That additional screening, as long as it occurs on the same encounter -- and your scenario seems to indicate it does -- then the measure is considered met. If the recommendation is to follow up with additional screening but the additional screening does not occur on the same encounter, the intent of the measure has not been met. Additionally, if you find that there is additional screening that occurred later on in the measurement year, then you would use that more recent screening for submitting on that measure. But specific to your scenario, if these are the most recent screenings, you have a PHQ-2 followed by a PHQ-9 that occur on the same encounter, the measure is considered met, as you've indicated that the provider has reviewed both of those screenings. Thank you. Great. Thank you. Our next question says, "MH, when you have a mentally disabled, challenged patient living in a group home, unable to complete PHQ- 9, can they be disqualified?" So, there's a couple things going on here. First of all, I would say, for the MH-1 measure, Depression Remission at 12 Months, what you want to ensure -- that PHQ-9 is part of your denominator criteria. So, regardless of the circumstances, if you do not have a PHQ-9 greater than 9 during the index period, that patient is not considered denominator-eligible for the measure, and you would select the appropriate -- I think it's "no to a PHQ-9 greater than 9" selection, and that patient will be skipped and replaced. So, you don't need reasons such as dementia or mental issues for not completing the PHQ-9. If there is no PHQ-9 or there is no PHQ-9 greater than 9 result, then that patient would not be considered denominator-eligible, and you should skip them, and they'll be replaced. Thank you. Thank you. Our next question is on CARE-1. "If a patient is discharged from a hospital to a skilled nursing facility and so may not have had a 'office visit' for a while, if at all, is this considered a discharge? And if not, how do we record this without it counting against us for the measure? 3

4 Hi. This is Kayte from the PIMMS team. So, in this scenario, you do have the information to confirm the discharge. However, if the patient did not have an outpatient follow-up within 30 days, you can answer no to that question, and then that is complete reporting in that scenario. Thank you. Thank you. Our next question is on MH-1. "If we have two PHQ-9s in the measure-specific time for measure specification time frame, the first one being over 9 and the second one is below 5, should we use the most recent?" And then they're also asking if the patient was able to be in remission in less than a year? This is Deb from the PIMMS team, and this is actually a question we currently have in our queue. The thing to really pay attention to and what might be the most helpful is the measure calculation flow. Your first steps are determining your denominator eligibility. So, if you find that the patient has the appropriate diagnosis, you can confirm that, and during that denominator identification period, with that diagnosis, there is also a PHQ- 9 greater than 9, the guidance from the measure developer is to use that first instance of the PHQ-9 greater than 9 during the denominator identification period to basically set your clock. And what that does is that's setting your 12 months, plus or minus 30 days, to determine if the patient has achieved remission with a PHQ-9 less than 5 result. If you find that there's a PHQ-9 less than 5 result at six months, that does not meet the intent of the measure. You have to show that there is a PHQ-9 less than 5 at 12 months, plus or minus 30 days from that index date. And, again, that index date is the date where you found the PHQ-9 greater than 9 during the denominator-identification period, which, for the 2018 program year, was 12/1/2016 to 11/30/2017. This will be the same answer that we provide in your current case, so if you have some additional questions, please feel free to add those to that particular case, and we can address them at the same time that we're addressing this in that particular case. Thank you. Thank you. And, Stephanie, do we have any phone questions at this time? Our first question is from George Zelenkov. George, your line is open. Sorry. I was muted. This is a question dealing with PREV-9, the BMI followup. Regarding the last question that was asked during last week s call, regarding an approved BMI -- and I did request a ticket, and I just wanted more clarification on it. If we have a patient whose most recent BMI -- we'll call it May 5th -- is out of range and there is no follow-up, but this patient also had a BMI taken February 4, 2018, also out of range, with a follow-up plan exercise or diet, but it was dealing with hypertension and nothing dealing with BMI, can that be numerator-compliant? This is Deb from the PIMMS team. I think you've got a couple of things going on, and I would recommend kind of starting again with the measure flows. So, you're looking for, I believe, your most recent encounter, and then you have a 12-month window to look back. So, if you have that May 5th, an abnormal BMI, no follow-up, and you're still within this 12-month look-back period you find on February 4th, you also have documentation of an abnormal BMI, and that recommended follow-up, even though it's for hypertension -- is also relevant to the abnormal BMI -- you can use it. And the rationale behind that is that you're often going to have patients that are going to have multiple issues. So, they may be a diabetic who has hypertension whose BMI is abnormal. And the provider isn't necessarily going to say, "I need you to 4

5 watch your diet, and I need you to exercise for your BMI, your diabetes, and your hypertension." That recommendation really is to address all of the issues that are going on. So, we take that into account when we're looking at it, but, first and foremost, when you're looking at your dates, ensure that you're following that measure specification and the timing that's allowed. And as long as it's fitting the timing of the measure spec, you can certainly look back for another abnormal BMI with a recommended follow-up, and it doesn't necessarily have to say it's for the abnormal BMI, as long as it's relevant for the BMI, as well as for other conditions that may have occurred on that same encounter. Does that help? Yeah, absolutely. Thank you so much. You're welcome. All right. Our next chat question is from an ACO, and they're asking about PREV-10, tobacco screening. So, they're asking, "If there is documentation that indicates that the patient is a former smoker but then there are also comments by the provider in the patient's chart that say something that contradicts that -- for example, saying that the person occasionally smokes cigars or takes a puff of a pipe on weekends or during summertime, should patients with these or similar comments be identified as smokers or nonsmokers?" Hi. This is Angie from PIMMS. First of all, it sounded like, yeah, that you had a documentation of a former smoker, which would indicate a non-tobacco user, and then also comments indicating that some type of tobacco use is still taking place. So, you would need to work with the eligible clinician and research the medical record to see the date that these comments were added, at which encounter they applied, because you want to use the most recent documentation of the tobacco-use status. Should patients with comments such as "occasionally smokes" or "sporadically takes a puff off husband's cigarette once in a while, they would still be considered as a tobacco user. Any type of tobacco use would be considered positive for the tobacco screening. Thank you. Thank you. And our next question is also on PREV-10. "If the patient was assessed twice within a few months apart and tobacco cessation was not performed at the most recent visit but the patient was prescribed tobaccocessation medications at the previous encounter and those medications are still active, does this count for the numerator?" The expectation is that, if the patient is identified as still using tobacco at the most recent visit, that tobacco cessation should be given at that encounter or after that encounter. Even if the patient has an active tobacco cessation/intervention drug in their medication list, there needs to be some type of documentation that the patient's continued tobacco use is addressed at that encounter with the most recent tobacco use status. Thank you. Thank you. And this next question is on P-12, depression screening. "If we see a standardized tool, such as questions without a title or documentation depression screening score zero of 10, is this acceptable for PREV-12 without the specific name of the tool in the documentation? 5

6 This is Deb from the PIMMS team. The one thing you do need for confirmation in the PREV-12 measure, as far as the standardized depression screening tool is concerned, you do need documentation that can show that it is a normalized and validated depression screening tool. So, I think you would need to have the actual name of the screening tool. However, if you find that there's another way that you're identifying it as a standardized depression screening tool and that doesn't include the name of the tool, please feel free to open up a QualityNet Help Desk ticket, and we can review that. Otherwise, I would say, yes, you do need the name of the depression screening tool just to show that it is a normalized and validated tool being used. Thank you. Thank you, and for this next question, this person's asking to clarify a brief use of a medication relative to IVD since the heparin flush would not exclude the patient. And then they're asking, "What if multiple flushes were given to a patient over a hospital stay? Would this still be considered brief use?" Hi. This is Olga Kogan from the PIMMS team. Yes, that would still be considered brief use. If the heparin was prescribed for the patient on an ongoing basis, then it would meet the denominator exclusion. Thank you. And, Stephanie, we can take a phone question at this time. Our next question comes from Susan Herbert. Yes, hi. Thank you for taking my question. We heard, on one of the previous calls, that we should make every effort to obtain medical records both from ACO participants, as well as non-aco participants, if we believed that they had information that would satisfy the measure. My question is, in going after medical records for non-aco participants, is there any kind of special authorization that we need from the beneficiary in order to be able to do that? Hi. This is Amy with ACO PAC. I believe we have an open Help Desk ticket with this question. Is that correct? Yes, I submitted one. Okay, we'll have to defer to that and get back to you shortly. Okay. Thank you very much. All right. Our next chat question asks, "Does Cologuard meet requirements for PREV-6 colorectal screening?" Hi, this is Olga from the PIMMS team. Yes, Cologuard is considered FIT DNA testing, and the 2018 PREV-6 measures specification identifies that the fecal immunochemical DNA test, the FIT DNA, during the measurement period or the two years prior to the measurement period would be considered acceptable. Thank you. And the next question's on PREV-13. "If a patient had a liver transplant in 1989, would this exclude them from the denominator?" 6

7 Hi. This is Angie from PIMMS. Patients with active liver disease or had a disease or insufficiency may be reported as a denominator exception. The denominator exception should be active during the measurement period. So, there would need to be documentation in the measurement year that the reason statin was not prescribed is due to the liver transplant. Thank you. Thank you. This next question asks, "When verifying that the patient is not in a MA product or Medicare HMO product, is this something that CMS has validated, or do we need to verify this through our practice business systems?" This is Kristin from RTI. Then, providing the sample, if the Medicare data as of October 31, 2018, indicated that the beneficiary did not have fee-forservice Medicare, then they were excluded from the sample. But if the Web Interface user finds additional information or more recent information indicating that they no longer have the fee-for-service Medicare, then they should update that and exclude the beneficiary from the measure. Great. Thank you. And this next question's on mental health follow-up. "Do you have to see the questions in the chart, or is the PHQ-9 score enough to indicate that the screening was done?" This is Deb from the PIMMS team, and I'm going to answer this from the perspective of the MH-1 Depression Remission at 12 Months measure. That particular measure, you can actually do the PHQ-9 in any number of ways, so as long as you have documentation of the result of that PHQ-9, that's all that's needed. Thank you. Thank you. And, Stephanie, do we have any questions on the phone at this time? There are no additional questions at this time. All right. Thank you, Stephanie. Our next question says, "If a patient is screened for tobacco use and found to be a smoker but counseling is not done at this visit, because the patient had a referral to the quit line done at a previous visit, does this meet the measure?" Hi. This is Angie Stevenson. No, that does not meet the intent of the measure, and I'm going to go a little further. There was another question -- Well, there were several questions about the screening and the patient being determined to be a tobacco user at the most recent visit with no cessation. If there's no cessation done at the most recent screening, where the patient was identified to still be a tobacco user, regardless of previous visits where screening was done or cessation was given, it would not meet the measure if no additional tobacco cessation was done for that patient. Thanks very much. Thank you. And this next question, this person's asking to please clarify again on PREV-12. "If the patient is screened and determined that the patient has depression on the day of the screening, can we still include the patient in the measure, or would they be excluded?" This is Deb from the PIMMS team. You should actually include that patient, but in order to pass the measure in this situation, there has to be a 7

8 recommended follow-up. So, it sounds like there is a depression screen, the depression screen is positive, and you should be able to find a recommended follow-up based on that positive screen. Thank you. Thank you. This next question's on MH-1. "Is the measure considered a skip or a fail if a second PHQ-9 did not fall in the correct time frame?" This is Deb from the PIMMS team. So, I'm assuming you're referring to the PHQ-9 to show remission, so you've established denominator eligibility, and now you're trying to find out whether or not the patient has achieved remission during the 12 months, plus or minus 30 days. And if that PHQ-9 to show remission does not occur within 12 months, plus or minus 30 days, this would be considered a fail, as the patient has not achieved remission within the time period allotted by the measure. Thank you. Thank you. This next question's on CARE-2: Falls. "Does a fall assessment alone or gait-imbalance assessment alone meet the measure, or do we have to do both?" Hi. This is Olga from the PIMMS team. You do not need to have both. You can have screening for future falls risk, which includes an assessment of whether someone has experienced a fall, or you can have problems with gait or balance. So, for gait or balance, as long as there is "gait within normal limits" or "gait steady" or "gait unsteady," something related to the gait is documented during the measurement year, it'd be considered fall screening, as well. Thank you. And, Stephanie, do we have any questions on the phone? Stephanie, do we have any phone questions? We have a question from Pam Minichiello. Hi. Yes. Hello. Can you hear me? Yes. Yes, we can hear you. Thank you. I was following up on that PREV-10 question about the medication regimen. So, I just want to clarify. So, if a patient is seen twice and they are prescribed medication, not at the most recent encounter, but they received this medication, let's say, 30 days before, and they are for nicotine patches, which that regimen is going to take longer than 30 days to comply, that does not count for the numerator if it's not addressed again at the most encounter? Hi. This is Angie again. Yes, it does not count, and the rationale behind that from the measure owner is that -- Let's say you prescribed the nicotine patches at the first visit when the patient was identified as a tobacco user, and so that would meet intent. Then, at the next visit, the physician probably asked, "Are you still using tobacco?" The answer was yes, so again they were screened and again they were identified as a tobacco user. So, it's the expectation that that tobacco use is addressed at that visit by the physician again. That could be such a thing as saying, "How are you doing on your quitting smoking or tobacco use? And I'd like to see you continue on this nicotine patch, continue it for another so many weeks." But the intent 8

9 was clarified that it does need to be addressed at every encounter where it's identified. I can understand that. The issue lies, though, is that you have a multispecialty combined, shared record, right? So, if the patient is seen by the primary care provider and then prescribed those patches or prescribed CHANTIX -- or really anything, even a referral for a smoking cessation program -- and they come back in two weeks later, but they go to, let's say, a same-day-visit location because they fractured their thumb, they may assess it, but they're not going to address it because they're there for a fractured thumb, and they're already being treated. So, I guess where I get confused is that, the BMI, we can go back and look at the period, we can go back and look through the look-back period, but for this, we can't. So, this is Deb. I'll weigh in just on one piece of that, specifically the last part, and that is just to keep in mind that these are different measure developers that go through different standards with their measures, and so we can't compare the PREV-9, which is stewarded by NCQA, to the PREV-10, which is stewarded by PCPI. So, unfortunately, much like the PREV-12 Depression Screen and the MH-1 Depression Remission, the measures kind of have a different intent. They go through different testing and processes and are stewarded by different folks. So, I'll let Angie speak to the PREV-10 specifically because I understand your question, and I'm sure she'll try and address it or further clarify if she can, but as far as comparing the two measures, we're not able to do that. Right. I agree, Deb. And one thing that I wanted to mention -- I know it doesn't answer all of your questions, but you said in the case of the patient came in for a broken thumb a couple days later, there are denominator exceptions for medical reasons that you can use that would exclude that encounter. Okay, I won't take up the time. I'll just add that in. That wouldn't be an emergent or urgent... Okay. Thank you. You're welcome. All right. Our next question asks, "For BMI, does the timing of the followup start with the most recent encounter and look-back of less than 13 months, or does the timing for the look-back start on the date with the most recent BMI? And is it a look-back of less than 13 months?" So, this is Deb, and I'll point you to page 10 of the posted measure specification. The numerator submission does say to determine if the patient had a BMI documented during the most recent visit or in the last 12 months prior to the most recent visit. So, your starting point with this particular measure is your most recent visit. Thank you. Thank you. This next question is on the flu vaccine. They said that, "Last week, it was said that the flu vaccine is for the prior year, August 1, 2017 through March 31st of 2018 only, or can the flu vaccine also be for August 1, 2018 through December 31, 2018? This is Deb again from the PIMMS team. For the 2018 submission of Web Interface data, you're looking at October 1st of 2017 through March 31st of 9

10 2018 for the flu season. And you can, of course, submit previous receipts. That goes back to August, I believe. The flu season that would occur later in 2018 would be the flu season that would be measured in the 2019 Web Interface submission, not in the 2018 program year. The measure specification does have those dates outlined, so if I didn't articulate that very clearly, I would go and look at the measure specs themselves, and just remember that you're submitting one flu season for the 2018 program year, and that would be the flu season between October 1st and March 31st. Thank you. Thank you. This next question asks, "Could you clarify whether a FFS Medicare beneficiary with parts A and B with a supplemental plan that is the primary payer is excluded as if she or he were in an HMO?" Hi. This is Amy Mills. Yes, that's correct. If a Medicare beneficiary has a supplemental plan that's the primary payer, then that would qualify as nonfee-for-service and that beneficiary would be not qualified for the sample. Thank you. And, Stephanie, we can take a phone question at this time. Our next question is from Greg Nelson. Hi, yes. I had a question regarding PREV-7, as well. The initial population, of course, states that it's anybody, I think, six months or over. The denominator specifically states that they have to have been seen between October 1st and March 31st, 2017 through If they weren't seen during that time frame, there doesn't seem to be a place within the spreadsheets to indicate that as a way to exclude them. We've got the "not qualified for sample," of course, but that's the hospice stuff. Where would we indicate that the patient wasn't seen at all during that time frame to remove them from being reported on or to exclude them? So, this is Deb, and I'll answer from the measure perspective, and then there may be someone on that wants to answer from the assignment and sampling perspective. Basically, our understanding is, is that those patients that have been attributed have been attributed based on the fact that they had visits that occurred between October 1st and March 31st. So as far as the Web Interface is concerned, we don't have an area for you to skip that patient because you're saying you weren't able to find them. I don't know who's on from -- if it's Sarah or maybe Olivia that can address maybe what should be done if they've kind of gone through all of their records and truly cannot find that a patient has had an encounter between October 1st and March 31st? Hi. This is Amy Mills, and I can speak to the sampling perspective. As Deb said, the beneficiary was sampled based on Medicare claims submitted by one of your participating TINs, so they have had at least -- I think it's one encounter during the flu season and then, of course, the qualifying visit to be sampled into the Web Interface. And you can read more about that in the "Sampling Methodology" document. So, if we can't find it in our EMRs, then we would just... just leave it as a "no, they didn't get it," if we can't find that? I've had very few. I think I had one where I truly looked through everything and couldn't see that we had seen them, but there was one, and I just gave us a "no" on it, 10

11 and we failed because I couldn't find a place to exclude it. That would be the approach then, just call it a fail? I'll defer to PIMMS on how to report it. I can just verify that we have Medicare claims indicating that the beneficiary has been seen. Sir, again, if you're not -- This is Deb. If you're not able to find that flu vaccine and, as Amy said, if the only way that patient would have been attributed is to show that they had a visit during that appropriate time period, then I don't know that there is another option but to say that they didn't receive the flu vaccine, because as I said earlier, there's no place within the Web Interface, and it's purposefully done that you're saying, "I can't find this particular patient." Okay. Again, I think there's been one, but we just weren't sure how to handle that. Sure, sure. If you have additional problems or it seems to be something you see more often, it may be something you want to open up a case on, but if it's kind of one or two here or there, it could just be a matter of, for whatever reason, you're not to able to find them, but based on the methodology that was used, the patient was seen, and then, from the perspective of the measure, you would just report that you can't find the flu vaccine either. Appreciate it. Thank you. Thank you. All right. Our next question asks, "Is there a limitation in uploading data?" And the person says that they are getting an error message that CMS is unable to identify as of today, but they think that they're working on it, and this person said that CMS said it might be related to a limitation on the amount of time that you can spend logged into the site. Hi. This is Ozlem. There is no limit to the number of times you can upload the Excel file. You can upload it as many times as you'd like. There is also no limit to the number of times you can log in to QPP or access the Web Interface. If you are having specific issues or receiving errors trying to log in or trying to upload, please open a Help Desk ticket and include a screenshot and detailed explanation of the error you are receiving so that we can look into it. Thank you. Thank you. And this next question is on PREV-6. "Can you please clarify the POS code 32? If a patient was in a skilled rehab facility for a knee replacement, for example, can they be excluded per POS code 32? Hi. This is Kayte from the PIMMS team. So, I do want to clarify this would apply to any measure with a Place Of Service code exclusion, but if services for the patient were billed using Place Of Service code 32 during the measurement period and there's supporting documentation, you can use the exclusion. If they were in a skilled nursing location or any other type of rehabilitation but the services weren't billed to Place Of Service 32, you would not be able to use the exclusion. So, as long as those services were billed using the appropriate code, there's supporting documentation, you can 11

12 claim an exclusion. However, it's important to note that the patient must be 65 or older, in addition to having those codes. Thank you. Thank you. And this next question is on CARE-1, and they're saying that they heard that CARE-1 is pay-for-reporting only this year. Is this correct? This is Kristin from RTI, and, yes, that is correct. CARE-1 is pay-forreporting this year. Thank you. And this next question is on CARE-2. "Can the fall risk or gait balance screening be done at a hospital encounter or during a telephone encounter with an eligible provider?" Hi. This is Olga from PIMMS. The setting of the screening is not restricted to an office setting, and, yes, it can be completed during a telehealth encounter. Thank you. And, Stephanie, we can take a phone question at this time. There are no phone questions at this time. Press star-1 if you have a question. All right. Thank you. And let's see. Our next question here... it's another follow-up on the tobacco measure. It says, "Part of the tobacco screening workflow intervention readiness is assessed, but the patient refuses additional intervention. Does this meet the cessation requirement?" Hi. This is Angie. I just wanted to address the refusal portion of this measure. So, as long as there's medical record documentation that tobacco cessation intervention was attempted by the provider, then the intent of the measure is met. It doesn't matter if the patient refuses the suggested tobacco-cessation method, because the measure's not measuring compliance with the cessation. It's just measuring that the patient was screened and given the cessation. Thank you. Thank you. All right. Our next question, the person's asking, "If a patient has an appointment in October of 2017 but had a shot in September of 2017, would we mark the patient as receiving a flu shot?" This is Deb. Yes, you can actually report previous receipt of the flu shot. So, the fact that the patient received a flu shot on September 17th of 2017, this would be within the appropriate time frame, and that patient would be considered compliant. Thank you. Thank you. Our next question -- I just... I'm sorry. I just want to mention the time frame is from August 1, 2017 through March 31st of So, if there is previous receipt of the influenza immunization reported or there's record that it was given during that time period, then you would select "yes" and meet the intent. Thank you. And our next question, the person's asking, "If a patient has a group employer plan as primary with regular Medicare as secondary, do they still qualify for the measure, or do they fall under the non-ffs Medicare?" 12

13 Hi. This is Amy. Anyone with non-fee-for-service Medicare as their primary would not be qualified for this sample. So, I believe, in this case, they're saying that the group insurance is their primary -- or their employer insurance, so you could mark not qualified for the sample in this case. All right. And this next question asks, "Will the 2018 tobacco measure benchmarks be re-evaluated and published since this measure is new?" And they also note that, based on the questions asked, it appears that ACOs may have varied to reporting on the tobacco measures prior to This is Kristin from RTI. In 2018, the PREV-10 benchmark has been updated this year. The rate is based off of data elements that reported in previous years, and so a new benchmark was created for the new rate that is reported. Great. Thank you. And this next one's not actually a question, but somebody did put in a comment regarding that upload error, and they said that they did have the same issue but that it resolved after removing the provider I.D. numbers, based on the Help Desk recommendation. Hi, Mikala. This is Ozlem. So, this is referring to an upload error, as opposed to a log-in or number of times that they can upload. So, there is, again, no limit to the number of times that they can upload. Currently, there is a known issue around the upload where, if users change the provider 1, 2, and 3 information for a beneficiary in the Excel file, then when they upload [this file, they] will get a validation error. We are working on the fix, and soon [the issue will be corrected in the CMS Web Interface]. However, there is a work-around. They can delete or remove the providers' columns from the Excel files and upload the files, and the file upload should be processed correctly. This is an upload error around providers' columns. If the [provider] order has been swapped in the Excel file, the system will throw this validation error. A fix would be published to production soon, but, in the meantime, users can just remove those columns and be able to upload [their Excel file]. 1 Thank you. Thank you, Ozlem. And, Stephanie, do we have anyone on the phone? We have a question from Adam Durst. Hi. My question was regarding PREV-9 BMI, specifically the follow-up plan requirements. We've been finding a lot of follow-up plans printed in the AVS that's handed to the patient but nothing really documented within the physician's progress note. Would that be sufficient to satisfy the numerator requirement for the follow-up plan? So, this is Deb from the PIMMS team. Having not quite heard that question before, it may be best if you submit a Help Desk ticket. I will tell you, for an abnormal BMI, as long as there is documentation on the date of that encounter that there was a recommended follow-up and it is in the patient's medical information, it can certainly be used, but I'm not 100% sure what you're referring to, so if that doesn't answer your question, I would 1 The brackets include text that has been added to the transcript to convey what was being presented when the speaker was inaudible. 13

14 recommend a Help Desk ticket, and we can look at it in a little more detail and provide you a written response. Thank you. You bet. All right. Our next question asks, "Is PREV-10 pay-for-reporting for 2018?" Hi. This -- For -- Oh, go ahead. No, go ahead, Kristin. I was just going to say that it does have benchmarks, and so, unless you're in your first performance year, PREV-10 is not payfor-reporting. It's only pay-for-reporting if you're in your first performance year for ACOs. Great. Thank you. And this next question asks, "Can telehealth encounters be used for PREV-12?" This is Deb from the PIMMS team. That particular answer is included on page 10 of the posted measure specification. Screening for depression may be completed during a telehealth encounter. That is part of your numerator guidance, so if you needed to be able to get that documentation and send it out to any of your abstractors, that's where it's located. Thank you. Thank you. And this is our last question that we have time for today, and it asks, "What do you do when you can't confirm a discharge date?" This -- This is Kayte from -- Oh, go ahead, Deb. No, that's okay, Kayte. If you can't confirm that discharge, you would just select "no" to the discharge. Thank you. Thank you. And that is all the time we have for today. If we can go to the next slide, please... And if we weren't able to answer your question, please do feel free to e- mail those addresses for help with the Quality Payment Program, the Medicare Shared Savings Program, and Next Generation. We sent those s out earlier as an announcement that you should've seen pop up on your screen, but here they are again for you. And we also encourage you to join us for our next webinar on February 27th. Thank you. Thank you. This concludes today's conference. You may now disconnect. Speakers, please hold the line. 14