AdvantEdge Healthcare Solutions: 2012 Physician Quality Reporting System (PQRS) Manual

Transcription

1 AdvantEdge Healthcare Slutins: 2012 Physician Quality Reprting System (PQRS) Manual This newsletter cntains the fllwing infrmatin: 1. Eligible Prfessinals Page 1 2. PQRI Basics Page Reprting Optins Page 2 A. Individual Measures Page 3 B. Measures Grups Page 3 C. Grup Practice Reprting Page Reprting Mechanisms Page 7 A. Claims-based Page 8 B. Registry-based Page 8 C. EHR-based Page 8 5. Certificate f Maintenance Page 9 6..Measure Applicability Validatin (MVA Page 9 7. ADDENDUMS Addendum A Eligible Prfessinals Page 12 Addendum B New Individual Measures Page 13 Addendum C GPRO Measures Page 13 Addendum D EHR Measures Page 15 Addendum E Measures Grups Measures Page 17 Addendum F Steps t Billing PQRS Measures Page 21 DEFINITIONS Fr the purpses f this manual, the fllwing abbreviatins will be used t be in sync with the CMS manuals and fr simplificatin purpses: EP Eligible prvider QDC (Quality Data Cde) PQRS Cde GP Grup Practice 1 - ELIGIBLE PROFESSIONALS (EPs) A listing f all prviders eligible t participate in 2012 is lcated in Addendum A at the end f this newsletter. Included with physicians are PA s, NPs, psychlgists, scial wrkers, therapists and ther nn-physician prfessinals. PQRS measures are analyzed by the individual NPI number even if the member is part f a grup. The exceptin is if a grup practice f 25 EPs r mre reprts their measures thrugh the Grup Practice Reprting (GPRO) methd, in which case the grup s NPI number wuld be used in analyzing measure data PQRI BASICS Currently, PQRS is a vluntary individual reprting prgram t reprt data n quality measures fr cvered Physician Fee Schedule (PFS) services furnished t Medicare Part B beneficiaries (including Railrad Retirement Bard and Medicare Secndary Payer). Medicare C (Medicare Advantage) beneficiaries are nt included in claim-based reprting f individual measures r measure grups, GPRO reprting r HER Reprting. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 1

2 2012 Incentive Payments will be 0.5% f a prvider s ttal Medicare allwable charges fr successful reprting 2011 was 1% 0.5% will be applied t incentive payments fr years All claims fr service dates f January 1, 2012 December 31, 2012 must be reprted by February 22, 2013 t be included in the analysis fr an incentive payment. Beginning in 2015, a payment adjustment will apply under the PQRS Incentive Prgram if the EP des nt satisfactrily submit data n quality measures fr cvered prfessinal services fr the quality reprting perid fr the year. The fee schedule amunt fr services furnished by such EPs will be reduced by the fllwing percentages: 1.5 percent fr 2015; and 2.0 fr 2016 and each subsequent year Services nt reprted in the 12 mnth reprting perid f January 1, 2013 thrugh December 31, 2013 will result in the fee schedule reductin in the year There are a ttal f 210 measures, which includes 206 individual quality measure and the 4 measures in the Back Pain measures grup, which are nt reprtable as individual PQRS quality measures. 32 new measure were intrduced fr 2012 (See Addendum B) Measures T Be Remved fr 2012 and replaced with #110 Preventive Care and Screening: Influenza Immunizatin #79 End Stage Renal Disease: Influenza Immunizatin in Patients with ESRD #135 Chrnic Kidney Disease(CKD) Influenza Immunizatin #175 Pediatric Stage Renal Disease (ESRD): Influenza Immunizatin Measures T Be Remved fr 2012 and replaced with #241 Ischemic Vascular Disease(IVD): Cmplete Lipid Panel and Lw Density Lipprtein (LDL-C) Cntrl #202 Ischemic Vascular Disease(IVD): Cmplete Lipid Prfile #203 Ischemic Vascular Disease (IVD) Lw Density Lipprtein (LDL-C) Cntrl Measures T Be Remved Permanently in 2012 #94 Otitis Media with Effusin(OME) Diagnstic Evaluatin Assessment f Tympanic Membrane Mbility (the measure #153 Chrnic Kidney Disease(CKD):Referral fr Arterivenus (AVP) Fistula Measures t Be Remved fr Claims-based and Registry Only applicable t EHR Reprting #200 Heart Failure: Warfarin Therapy fr Patients with Atrial Fibrillatin PQRS REPORTING OPTIONS There are 3 methds f reprting: 1. Individual Measure Reprting 2. Measures Grups Reprting 3. Grup Practice Reprting Optin (GPRO) T participate in the 2012 PQRS prgram, individual EPs (Eligible Prfessinals) may chse t reprt infrmatin fr individual PQRS quality measures r measures grups t CMS via: 1. Claim-based reprting - n Medicare Part B claims 2. A qualified PQRS Registry, r 3. A qualified electrnic health recrd (EHR) prduct. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 2

3 Reprting Perids NEW: In 2012, there is nly ne reprting perid f 12 mnths. CMS has eliminated the 6-mnth reprting perid fr claims-based, registry (individual measures via a registry) and EHR-based reprting. The 6-mnth reprting perid is still available fr reprting measures grups via a registry mnths Service dates f January 1, 2011 December 31, mnths Service dates f July 1, 2011 December 31, 2011 (fr reprting measures grups via a registry nly) If a prvider participated in the 2011 PQRS prgram and wants t reprt the same measures fr the 2012 prgram, the prvider must: determine if the measure is still available check the Release Ntes t determine if the criteria fr these measures changed in The Release Ntes manuals are specifically written t shw nly the changes frm 2011 t The names f the manuals are listed belw and can be fund n ur Public server in the PQRS flder r by clicking n the belw PQRS Measures link. Fr Individual Measures 2012_PhysQualRptg_MeasureSpecsificatinsManual_ReleaseNtes_ Fr Measures Grups 2012_PhysQualRptg_MeasuresGrups_ReleaseNtes_ Fr GPRO Release Ntes are nt yet available n the CMS website Fr EHR Reprting 2012_EHR_MeasureSpec_ReleaseNtes_Nv2011.v3.1pdf PQRS Measures A. INDIVIDUAL MEASURES REPORTING Claims-based individual measures reprting remains similar t last year. EPs must reprt a minimum f 3 measures fr at least 50% f their Medicare patients eligible fr each measure in rder t qualify fr the incentive payment unless the prvider nly perfrms less than 3 measures. Prviders wh reprt less than 3 measures will be subject t the measure-applicability validatin (MVA) prcess. Shuld Medicare find that the prvider submitted CPT and diagnsis cdes that wuld qualify him/her fr a 3 rd measure, the prvider will nt be paid fr the 2 measures r less submitted. Measures with a 0% perfrmance rate will nt be cunted Fr mre infrmatin n hw the measure-applicability validatin prcess is calculated, see Sectin 5 Measure Applicability Validatin f this Newsletter. Registry Reprting EPs must reprt at least 3 measures fr at least 80% f their Medicare patients eligible fr each measure in rder t qualify fr the incentive payment. Measures with a 0% perfrmance rate will nt be cunted B. MEASURES GROUPS REPORTING With the measure grups ptin, prviders may reprt n a grup f clinically-related measures either thrugh claims-based r registry-based submissin. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 3

4 Prviders nly need t reprt ONE measures grup t qualify fr PQRS payment. Mre than ne grup measure may be reprted but the EP will nly earn a maximum f ne incentive payment equal t 0.5% f the ttal estimated allwed charges furnished during the lngest reprting perid fr which he r she satisfied reprting criteria.. Each measure grup has an Intent G Cde. This cde is used nce t infrm Medicare that the prvider will be submitting via the Measures Grup reprting methd Each measure grup has a Cmpsite Cde. This cde is used if the EP is reprting n ALL measures within the measures grup. This cde is used instead f reprting each measure separately. There are 22 measures grups available fr reprting in All 14 measures grups frm 2011 will be available fr There are 8 new measures grups fr They are: COPD MEASURES GROUP CLAIMS,REGISTRY INFLAMATORY BOWEL DISEASE (IBD) MEASURES GROUP REGISTRY ONLY SLEEP APNEA MEASURES GROUP REGISTRY ONLY DEMENTIAL MEASURES GROUP REGISTRY ONLY PARKINSON S MEASURES GROUP REGISTRY ONLY ELEVATED BLOOD PRESSURE MEASURES GROUP REGISTRY ONLY CARDIOVASCULR PREVENTION MEASURES GROUP CLAIMS,REGISTRY CATARACTS MEASURES GROUP REGISTRY ONLY ADDENDUM E - lists all the Measures Grups, the measures within each grup, the Intent Cde, Cmpsite Cde and hw the measures may be submitted. Claims-based submissin The intent G cde must be submitted nly nce. This alerts Medicare that the prvider has chsen measure grup submissin f PQRS. As an example, G8485 (the first cde) means: I intend t reprt the Diabetes Mellitus Measures Grup. The PQRS analysis will be initiated when the intent G cde is first submitted n a claim. Hwever, all claims meeting the grup measures criteria will be cnsidered in the analysis regardless f the date f service the G cde is initially submitted. As an example, if yu submitted several claims with the measures grup fr service date f 1/1/2012 but yu did nt submit the intent G cde claim until service date 1/8/12, the payment analysis will begin with the service dates f 1/1/2012 that were submitted befre the intent G cde. Registry-based submissin The intent G cde des nt have t be submitted when reprting thrugh a Registry unless the Registry will reprt via claims data. The Registry wuld infrm the prvider whether t submit ne claim with the intent G cde There are 2 methds f submitting measure grups. 30 Patient Sample Methd If the prvider feels he/she has a minimum f 30 separate Medicare patients that will fit ne f the measure grups, he/she may chse t just submit infrmatin n thse patients. 12-mnth reprting perid nly May reprt via claims-based r registry reprting Measure grups cntaining a measure with a 0% perfrmance rate will nt be cunted Fr bth claims-based and registry-based reprting, all applicable measures within the grup must be reprted at least nce fr each patient within the sample ppulatin seen by the EP during the reprting perid. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 4

5 Percentage Patient Sample Methd If the EP des nt have 30 patients that wuld fit int a methds grup, then the Percentage Patient Sample methd wuld be used. Fr Claims based reprting 50% patient sample methd The EP must reprt n all applicable measures within the selected measures grup fr at least 50% f all patients during the selected reprting perid A minimum f 15 separate patients must meet the sample criteria Measure grups cntaining a measure with a 0% perfrmance rate will nt be cunted Fr Registry reprting 80% patient sample methd The EP must reprt n all applicable measures within the selected measures grup fr at least 80% f all patients during the selected reprting perid 12 mnth reprting a minimum f 15 patients must meet the sample criteria 6 mnth reprting (July 1, 2012 Dec. 31, 2012) a minimum f 8 patients must meet the sample criteria Measures grups cntaining a measure with a 0% perfrmance rate will nt be cunted Individual measures within the Measures grups may have different criteria and specificatins than the same measure reprted individually. Individual measures within the measures grups may have als changed since Therefre, it is imprtant that the requirements fr each measure are reviewed within the specificatins and instructins fr measures grup reprting. These requirements are prvided in a separate manual frm the individual measures. Fr infrmatin, click belw t the Measures Grup page n the CMS Website. Measures Grups Fr general infrmatin n Measures Grups: Getting_Started_with_2012_PhysQualRptg_Measures_Grups_ Fr detailed infrmatin n each measure and hw t reprt them: Grup Reprting: CMS: 2012_PhysQualRptg_MeasuresGrup_SpecificatinsManual_ T review all changes frm 2011: 2012_PhysQualRptg_MeasuresGrups_ReleaseNtes_ C. GROUP PRACTICE REPORTING (GPRO) CMS definitin f a grup practice, fr the purpse f submitting thrugh the GPRO methd, is a practice with a single TIN with 25 r mre Medicare eligible prviders, as identified by their individual NPI, wh have reassigned their billing rights t the TIN. (This is a change frm 2011 where there were 2 GRPO reprting ptins depending n the size f the grup practice) Methds fr submitting: GPRO ptins can nly submit thrugh a web interface prvided by CMS CMS will assign patients t participate by using Medicare Part B claims data fr service dates n r after January 1, 2011 and claims submitted and prcessed by Octber 31, All patients will be Original Medicare patients and Medicare must be their primary payer. Submissin requirements depend n the size f the Grup Practice. Grups EPs Must reprt via a submissin web interface prvided by CMS Must reprt n all GPRO measures included in the web interface Ppulate data field fr the first 218 cnsecutively ranked and assigned beneficiaries in the rder in which they appear in the grup s sample fr each disease mdule r preventive care measure AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 5

6 Grups 100+ EPs Must reprt via a submissin web interface prvided by CMS Must reprt n all GPRO measures included in the web interface Ppulate data field fr the first 411 cnsecutively ranked and assigned beneficiaries in the rder in which they appear in the grup s sample fr each disease mdule r preventive care measure 12 mnth reprting perid (Jan. 1, 2012 Dec. 31, 2012) There are 29 measures available fr GPRO reprting. (See ADDENDUM C) GPRO Eligibility Criteria If a grup has prviders wh are nt established Medicare prviders, the grup may still participate as lng as at least 25 prviders are established Medicare prviders. EPs, as classified by their NPIs, wh d nt submit Medicare Part B claims fr PFS cvered prfessinal services during the reprting perid will nt be calculated in CMS payment calculatins. Prviders/NPIs wh are nt established Medicare prviders (must have billed Medicare fr services dates between Jan, 1, 2011 Octber 29, 2011), will nt be included in the incentive payment calculatins fr the grup. Individual EPs wh are members f a GP selected t participate in the PQRS GPRO prgram are nt eligible t separately earn a PQRS incentive payment as an individual EP under that same TIN. Once a GP s TIN is selected t participate in the GPRO, this is the nly methd f PQRS reprting available t the grup and all individual NPIs wh bill Medicare under the grup s TIN number. As prviders leave and jin grup practices thrugh ut the year, there culd be a discrepancy between the number f EPs submitted by the practice during the self-nminatin prcess and the number f EPs billing Medicare under the TIN. If there are mre NPIs in the Medicare claims than the number f NPIs submitted during self-nminatin prcess, this culd result in the practice being subject t different criteria fr reprting, In this case, CMS will ntify the practice f this finding as part f the selfnminatin prcess. The practice will then have the ptin f: either agreeing t being subject t the different criteria fr satisfactry reprting r pting ut f participatin as a grup practice. Clients interested in participating as a GPRO fr the first time must self-nminate themselves via a letter accmpanied by an electrnic file submitted in a frmat specified by CMS (such as Micrsft Excel) that includes the grup practices TIN(s) and name f the grup practice, the name and address f a single pint f cntact fr handling administrative issues as well as the name and address f a single pint f cntact fr technical supprt purpses. (Once the CMS web-tl is capable f accepting selfnminatin statements that will be the nly available methd t self-nminate. The web tl is expected t be ready fr the 2013 PQRS. The self-nminatin statement must als indicate the grup practice s cmpliance with the fllwing requirements: Agree t attend and participate in all mandatry GPRO training sessins Is an established Medicare prvider that has billed Medicare Part B n r after January 1 and prir t Octber 29 f the year prir t the reprting perid fr the respective year. (Fr 2012, the grup practice must have billed Medicare Part B n r after January 1, 2011 and prir t Octber 29, 2011) Agree t have the results n the perfrmance f their PQRS measures publicly psted n the Physician Cmpare Web site. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 6

7 Obtain and/r have access t the identity management system specified by CMS (such as, but nt limited t, the Individuals Authrized Access t CMS Cmputer Systems, r IACS) t submit Medicare clinical quality data t a CMS clinical data warehuse. Prvider CMS access (upn request fr health versight purpses like validatin) t review the Medicare beneficiary data n which PQRS GPRO submissins are funded r prvide t CMS a cpy f the actual data (upn request fr health versight purpses like validatin) CMS reserves the right t validate the data submitted by GPROs. Grups wh participated in the 2011 GPRO prgram wuld autmatically be qualified t participate in the GPRO in 2012 and in future years. They will hwever, need t ntify CMS in writing f their desire t cntinue participatin in the PQRS prgram fr The self-nminatin letter must be pstmarked by January 31, PQRS REPORTING MECHANISMS The fllwing are all the ptins fr PQRS submissin. 1. Claims-based reprting: individual measures (12 mnths) ne measures grup fr 30 Medicare Part B FFS (Fee fr service) patients (12 mnths) ne measures grup fr 50 percent f applicable Medicare Part B FFS patients f each eligible prfessinal (with a minimum f 15 patients) (12 mnths) Measures with a 0 percent perfrmance rate will nt be cunted 2. Registry-based reprting: at least 3 individual PQRS measures fr 80 percent f applicable Medicare Part B FFS patients f each eligible prfessinal (12 mnths) ne measures grup fr 30 patients (patients may include, but may nt be exclusively nn- Medicare patients) (12 mnths) ne measures grup fr 80 percent f applicable Medicare Part B FFS patients f each eligible prfessinal (with a minimum f 15 patients) (12 mnths) ne measures grup fr 80 percent f applicable Medicare Part B FFS patients f each eligible prfessinal (with a minimum f 8 patients) (6 mnths) Measures with a 0 percent perfrmance rate will nt be cunted 3. GPRO based reprting: EPs in a GPRO grup Reprt n all measures included in the web interface and ppulate data field fr the first 218 cnsecutive ranked and assigned beneficiaries in the rder in which they appear in the grup s sample. If the pl f eligible assigned beneficiaries is less than 218, then reprt n 100% f assigned beneficiaries 100+ EPs in the GPRO grup Reprt n all measures included in the web interface and ppulate data fields fr the first 411 cnsecutively ranked and assigned beneficiaries in the rder in which they appear in the grup s sample. If the pl f eligible assigned beneficiaries is less that 411, then reprt n 100% f assigned beneficiaries 4. EHR-based reprting :: at least 3 PQRS measures and reprt each measure fr at least 80% f the EPs Medicare Part B FFS patients seen during the reprting perid t which the measure applies (12 mnths) measures with a 0 percent perfrmance rate will nt be cunted AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 7

8 A. CLAIMS-BASED REPORTING PQRS measures are reprted n each claim submitted t Medicare when the CPT and diagnsis cmbinatin qualifies fr the PQRS measures the prvider has chsen. Instructins fr billing via this methd are cntained in Addendum F at the end f this Newsletter. Submissin f PQRS may be by: Individual Measures Measures Grups B. REGISTRY REPORTING Prfessinals may submit their measures thrugh a Registry. A registry is a third-party database that many prfessinals already use t reprt data t researchers abut cmmn care prcesses fr diabetes, kidney disease and preventive medicine. An EP r grup practice wuld be required t enter int and maintain an apprpriate legal arrangement with a qualified PQRS registry. The Registry wuld act as a HIPAA Business Assciate and agent f the EP. CMS will pst a list f qualified registries n their PQRS website. Hwever, CMS des nt anticipate making this list available prir t the start f the 2012 prgram year. The names f the qualified registries will be psted in phases as fllws: 1. The registry s success in submitting PQRS quality measures data in a prir PQRS prgram year (2008, 2009, 2010, 2011) 2. The registry s submissin f a letter indicating their cntinued interest in being a PQRS registry by Octber 31 f the year prir t the prgram year (Octber 31, 2011) 3. The registry s cmpliance with the 2010 PQRS registry requirements as indicated by CMS vetting prcess.. Yu may access the current 2011 Qualified Registries by clicking belw, scrlling t DOWNLOADS and picking 2011 Qualified Registries PDF Qualified Registries C. EHR REPORTING (Electrnic Health Recrds) Fr 2012, EPs have the ptin f submitting quality measure data btained frm their PQRS qualified EHR t CMS either 1. Directly frm the EPs qualified EHR in the CMS-specified manner, r 2. Indirectly frm a qualified EHR data submissin vendr (n the EP s behalf), in the CMSspecified manner. Direct EHR Reprting EPs wh chse this methd must ensure their system is qualified t submit PQRS measures. An EHR system certified fr purpses f reprting under the Medicare and Medicaid EHR Incentive Prgrams may r may nt be qualified fr purpses f the 2012 PQRS prgram. The certificatin prcess fr EHR technlgy des nt test the EHR prduct s ability t utput a file that meets the PQRS measure file specificatins. CMS is currently explring ways t further align the qualificatins fr bth the PQRS and EHR Medicare/Medicaid Incentive Prgrams. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 8

9 Testing fr qualified direct EHR-based reprting prducts will ccur in late 2012, immediately fllwed by the submissin f the EP s actual 2012 PQRS data in early CMS expects t list the 2012 PQRS qualified EHR prducts by January EHR Data Submissin Vendrs CMS mandates the fllwing requirements fr individual EPs assciated with indirect EHR based reprting-based reprting: Selectin f a PQRS qualified EHR data submissin vendr, and Submissin f Medicare clinical quality data extracted frm the EHR t a qualified EHR data submissin vendr, which may include sme current registries, EHR vendrs, and ther entities that are able t receive and transmit clinical quality data extracted frm an EHR t CMS CMS expects t list the entities that are EHR submissin vendrs qualified t submit 2012 PQRS measures by mid Mre infrmatin is available n EHR reprting by clicking n the fllwing CMS website, scrlling t DOWNLOADS and clicking n 2012 EHR Dcuments fr Eligible Prfessinals PDF. This file will cntain tw gd resurces: Alternative Reprting Mechanisms CMS: 2012_2012_EHR_MeasuresSpecs_ReleaseNtes_Nv2011_v3.1.pdf CMS: 2012_EHR_MeasureSpecificatins_Nv 2011_v2.1.pdf. 5. CERTIFICATE OF MAINTENANCE T be cmpleted at a later date. 6. VALIDATION OF SATISFACTORY REPORTING When an EP reprts n fewer that 3 measures, CMS will perfrm a review t determine whether there are ther clsely related measures (such as thse that share a cmmn diagnsis r thse that are representative f services typically prvided by a particular type f EP). If an EP wh reprts n fewer than 3 measures in 2012 and reprts n a measure that is part f an identified cluster f clsely related measures and des nt reprt n any ther measure that is part f that identified cluster, then the eligible prfessinal will nt qualify as a satisfactry reprter in the 2012 PQRS prgram. The EP will then NOT earn an incentive payment n the less than 3 measures reprted. Measure-applicability validatin applies t prviders: wh submit QDC fr nly ne r nly tw PQRS measures fr at least 50% f their patients r encunters eligible fr each measure and wh d nt submit any QDCs fr any ther measure reprts less than 3 measures wh submit PQRS cdes via claim-based submissins Thse wh fail the validatin prcess will nt earn the PQRS incentive payments. Measures reprted via REGISTRY, GPRO r EHR are NOT subject t MVA. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 9

10 CMS will apply a tw-step prcess t peratinalize the MVA. 1. Clinical Relatin Test 2. Minimum Threshld Test Step 1: Clinical Relatin Test. This test is based n: 1. A presumptin that if a prvider submits data fr a measure, then that measure applies t her/his practice and 2. The cncept that if ne measure in a cluster f measures related t a particular clinical tpic r prfessinal service is applicable t a prvider s practice, then ther clsely-related measures (measures in that same cluster) may als be applicable. The fllwing is an example f hw the clinical relatin test will be applied: A prvider submitted PQRS cdes fr ne f the PQRS measures related t pneumnia. (pneumnia has 4 separate measures)that prfessinal s claims will then be analyzed using the minimum threshld test described belw t determine whether anther pneumnia measure (r tw mre pneumnia measures) culd als have been submitted. Clusters f clinically related measures are listed in the dwnlad sectin at the bttm f the article in the belw link labeled CMS MVA Infrmatin. Click n 2011 Physician Quality Reprting System Applicability Validatin Dcuments and yu will find 3 dcuments; a flw chart, full descriptin f the prcess and Release Ntes shwing nly changes frm last year. Step 2: Minimum Threshld Test. The minimum threshld test is based n the cncept that nly if, during the 2012 reprting perid, a prvider treated mre than a certain number f Medicare patients with a cnditin t which a certain measure applied, then that EP shuld be accuntable fr submitting the QDC(s) fr that measure. Fr the 2011 reprting perid, the cmmn minimum threshld, based n statistical and clinical frequency cnsideratins, will nt be less than 15 patients r encunters fr the 12-mnth reprting perid. CMS examples f hw the minimum threshld test will be applied: An emergency department (ED) physician treated 20 Medicare patients with pneumnia during the mnth reprting perid. If that ED physician is subject t validatin and was fund t have submitted a PQRS cde fr at least ne f the pneumnia measures under the clinical relatin test, then the physician wuld be deemed respnsible fr submitting PQRS cdes fr at least ne ther PQRS pneumnia measure. If the additinal cdes were nt submitted, the prvider will nt earn the 2011 incentive payment. Alternatively, if an internist was subject t validatin and was fund t have submitted a PQRS cde fr at least ne f the pneumnia measures under the clinical relatin test but treated nly 2 Medicare patients with pneumnia during the same perid, then the internist wuld nt be respnsible fr submitting the additinal pneumnia measures and wuld nt be precluded frm receiving an incentive payment. During the reprting perid, CMS will determine a minimum threshld fr each individual PQRS measure based n analysis f Part B claims data. Hwever, n threshld will fall belw the cmmn threshld f 15 patients r encunters described abve. AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 10

11 CMS may determine that it is necessary t mdify the measure-applicability validatin prcess after the start f the reprting perids. Hwever, any changes will result in the prcess being applied mre leniently, thereby (1) allwing a greater number f prfessinals t pass validatin and (2) causing n prfessinal wh wuld therwise have passed t fail. Infrmatin cncerning the Validatin Prcess alng with a listing f the validatin clusters can be fund by clicking belw and scrlling t DOWNLOADS t 2012 PQRS Measure Applicability Validatin Dcuments. Yu will find 3 dcuments: 2012_PhysQualRptg_MAV_PrcessfrclaimsbasedReprting_ pdf 2012_PhysQualRptg_MAV_ReleaseNtes_ pdf 2012_PhysQualRptg_MAV_Flw_ pdf PQRS Validatin AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 11

12 ADDENDUM A Eligible Prfessinals t reprt 2011 PQRS Measures 1. Medicare physicians 2. Practitiners 3. Therapists Dctr f Medicine Dctr f Ostepathy Dctr f Pdiatric Medicine Dctr f Optmetry Dctr f Oral Surgery Dctr f Dental Medicine Dctr f Chirpractic Physician Assistant Nurse Practitiner Clinical Nurse Specialist Certified Registered Nurse Anesthetist (and Anesthesilgist Assistant) Certified Nurse Midwife Clinical Scial Wrker Clinical Psychlgist Registered Dietician Nutritin Prfessinal Audilgists (as f 1/1/2009) Physical Therapist Occupatinal Therapist Qualified Speech-Language Therapist (as f 7/1/2009) Eligible But Nt Able t Participate The fllwing prfessinals are eligible t participate but are nt able t participate fr ne r mre reasns: 1. Prviders paid under the Medicare PFS billing Medicare fiscal intermediaries/macs. The FI/MAC claims prcessing systems currently cannt accmmdate billing at the individual physician r practitiner level: Critical access hspital (CAH), methd II payment, where the physician r practitiner has reassigned his r her benefits t the CAH. In this situatin, the CAH bills the regular FI fr the prfessinal services prvided by the physician r practitiner. All institutinal prviders that bill fr utpatient therapy prvided by physical and ccupatinal therapists and speech language pathlgists (fr example, hspital, skilled nursing facility Part B, hme health agency, cmprehensive utpatient rehabilitatin facility, r utpatient rehabilitatin facility). This des nt apply t skilled nursing facilities under Part A. Prviders nt defined as eligible prfessinals in the Tax Relief Health Care Act f 2006 r the Medicare Imprvements fr Patients and Prviders Act f 2008 are nt eligible t participate in PQRS and d nt qualify fr an incentive. Services payable under fee schedules r methdlgies ther than the PFS are nt included in PQRS (fr example, services prvided in federally qualified health centers, independent diagnstic testing facilities, prtable x-ray suppliers, independent labratries, hspitals [including critical access], rural health clinics, ambulance prviders, and ambulatry surgery center facilities). In additin, suppliers f durable medical equipment (DME) are nt eligible fr PQRS since DME is nt paid under the PFS. Eligible prfessinals participating in the PQRS shuld familiarize themselves and their ffice staff with the PQRS measures that appear t apply t their patients fr the relevant prgram year AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 12

13 ADDENDUM B New Individual Measures fr Chrnic Wund Care: Use f wund surface culture technique in patients with Chrnic Skin Ulcers - Claims, Registry Chrnic Wund Care: Use f Wet t Dry Dressings in Patients with Chrnic Skin Ulcers - Claims, Registry Substance Use Disrders: Cunseling Regarding Psychscial and Pharmaclgic Treatment Optins fr Alchl Dependence - Claims, Registry Substance Use Disrders: Screening fr Depressin amng Patients with Substance Abuse r Dependence - Claims, Registry Crnary Artery Disease (CAD): Symptm Management - Registry Only Cardiac Rehabilitatin Patient Referral Frm an Outpatient Setting Registry Only Hypertensin: Bld Pressure Cntrl Registry Only Barrett s Esphagus: - Claims, Registry Radical Prstatectmy Pathlgy Reprting: Claims, Registry Immunhistchemical Evaluatin f HER2 fr Breast Cancer Patients Claims, Registry Anticagulatin fr Acute Pulmnary Emblus Patients- Claims, Claims, Registry Pregnancy Test fr Female Abdminal Pain Patients Claims, Registry Ultrasund Determinatin f Pregnancy Lcatin fr Pregnant Patients with Abdminal Pain Claims, Registry Rh Immunglbulin (Rhgam) fr Rh Negative Pregnant Wmen at Risk f Fetal Bld Expsure Claims, Registry Surveillance after Endvascular abdminal Artic Aneurysm Repair (EVAR) Registry Only Statin Therapy at Discharge after Lwer Extremity Bypass (LEB) Registry Only Rate f Open AAA Repair withut Majr Cmplicatins (discharged t hme n later than pst-perative day #7) Registry Only Rate f EVAR withut Majr Cmplicatins (discharged t hme n later than POD #2) - Registry Only Rate f Cartid Endarterectmy fr Asymptmatic Patients, withut Majr Cmplicatins (discharged t hme n later than pst-perative day #2) - Registry Only Referral fr Otlgy Evaluatin fr Patients with Acute r Chrnic Dizziness Claims, Registry Image Cnfirmatin f Successful Excisin f Image-Lcalized Breast Lesin Claims, Registry preperative Diagnsis f Breast Cancer Claims, Registry Sentinel Lymph Nde Bipsy fr Invasive Breast Cancer Registry Only Bipsy Fllw-up Registry Only Epilepsy: Seizure Type(s) and Current Seizure Frequency(ies) Claims, Registry Epilepsy: Dcumentatin f Etilgy r Epilepsy r Epilepsy Syndrme Claims, Registry Epilepsy: Cunseling fr Wmen f Childbearing Ptential with Epilepsy - Claims, Registry Imprvement in Patient s Visual Functin within 90 Days Fllwing Cataract Surgery Registry Only Patient Satisfactin within 90 Days Fllwing Cataract Surgery - Registry Only Ischemic Vascular Disease (IVD): Cmplete Lipid Prfile and LDL Cntrl <100 - Claims, Registry Preventive Care and Screening: Bld Pressure Measurement - Claims, Registry??Preventive Care: Chlesterl-LDL test perfrmed - Claims, Registry Ischemic Vascular Disease(IVD): Cmplete Lipid Prfile and LDL Cntrl <100 - Claims, Registry AdvantEdge Healthcare Slutins 13 infrmatin@ahsrcm.cm

14 ADDENDUM C GPRO MEASURES 1 - Diabetes Mellitus: Hemglbin A1c Pr Cntrl in Diabetes Mellitus(>9%)** 2 - Diabetes Mellitus: Lw Density Lipprtein (LDL-C) Cntrl in Diabetes Mellitus** 3 - Diabetes Mellitus: High Bld Pressure Cntrl in Diabetes Mellitus** 5 - Heart Failure: Angitensin-Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) 6 - Crnary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed fr Patients with CAD 8 - Heart Failure: Beta-Blcker Therapy fr Left Ventricular Systlic Dysfunctin (LVSD)* 46 - Medicatin Recnciliatin: Recnciliatin After Discharge frm an Inpatient Facility* 52 - Chrnic Obstructive Pulmnary Disease (COPD): Brnchdilatr Therapy Preventive Care and Screening: Influenza Immunizatin* Preventive Care and Screening: Pneumnia Vaccinatin fr Patients 65 Years and Older* Preventive Care and Screening: Screening Mammgraphy* Preventive Care and Screening: Clrectal Cancer Screening* Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient Crnary Artery Disease (CAD): Angitensin-Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Patients with CAD and Diabetes and/r Left Ventricular Systlic Dysfunctin (LVSD)* Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw Up* Diabetes Mellitus: Ft Exam Crnary Artery Disease (CAD): Lipid Cntrl* Heart Failure: Left Ventricular Ejectin Fractin (LVEF) Assessment Heart Failure: Patient Educatin Ischemic Vascular Disease (IVD): Use f Aspirin r anther Antithrmbtic* Preventive Care and Screening: Tbacc Use: Screening and Cessatin Interventin* Heart Failure: Left Ventricular Functin (LVF) Testing Hypertensin (HTN): Cntrlling High Bld Pressure* Ischemic Vascular Disease (IVD):Cmplete Lipid Panel and Lw-Density Lipprtein (LDL-C) Cntrl * Preventive Care and Screening: Screening fr High Bld Pressure* lar Disease* -Use* * Measure als available fr reprting under the Medicare Shared Savings Prgram ** Measure is part f NQF #0729, Optimal Diabetes Care cmpsite, under the Medicare Shared Savings Prgram AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 14

15 ADDENDUM D EHR MEASURES EHR MEASURES THAT ARE ALSO EHR INCENTIVE PROGRAM CORE MEASURES Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw-up 237* - Hypertensin (HTN): Bld Pressure Measurement Preventive Care and Screening: Tbacc Use: Screening and Cessatin Interventin EHR MEASURES THAT ARE ALSO EHR INCENTIVE PROGRAM ALTERNATE CORE MEASURES Preventive Care and Screening: Influenza Immunizatin 239* - Weight Assessment and Cunseling fr Children and Adlescents Childhd Immunizatin Status EHR MEASURES THAT ARE ALSO EHR INCENTIVE PROGRAM MEASURES 1 - Diabetes Mellitus: Hemglbin A1c Pr Cntrl in Diabetes Mellitus 2 - Diabetes Mellitus: Lw Density Lipprtein (LDL-C) Cntrl in Diabetes Mellitus 3 - Diabetes Mellitus: High Bld Pressure Cntrl in Diabetes Mellitus 5 - Heart Failure: Angitensin-Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) 6 - Crnary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed fr Patients with CAD 7 - Crnary Artery Disease (CAD): Beta-Blcker Therapy- Prir Mycardial Infarctin (MI) r Left Ventricular Systlic Dysfunctin (LVEF < 40 percent) 8 - Heart Failure (HF): Beta-blcker Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) 9 - Anti-depressant medicatin management: (a) Effective Acute Phase Treatment, (b) Effective Cntinuatin Phase Treatment 12 - Primary Open Angle Glaucma (POAG): Optic Nerve Evaluatin 18 - Diabetic Retinpathy: Dcumentatin f Presence r Absence f Macular Edema and Level f Severity f Retinpathy 19 - Diabetic Retinpathy: Cmmunicatin with the Physician Managing Onging Diabetes Care 53 - Asthma: Pharmaclgic Therapy fr Persistent Asthma 64 - Asthma: Assessment f Asthma Cntrl 66 - Apprpriate Testing fr Children with Pharyngitis 71 - Breast Cancer: Hrmnal Therapy fr Stage IC-IIIC Estrgen Receptr/Prgesterne Receptr (ER/PR) Psitive Breast Cancer 72 - Cln Cancer: Chemtherapy fr Stage III Cln Cancer Patients Prstate Cancer: Avidance f Overuse f Bne Scan fr Staging Lw Risk Prstate Cancer Patients Preventive Care and Screening: Screening Mammgraphy Preventive Care and Screening: Clrectal Cancer Screening 308* - Smking and Tbacc Use Cessatin, Medical Assistance: a. Advising Smkers t Quit, b. Discussing Smking and Tbacc Use Cessatin Medicatins, c. Discussing Smking and Tbacc Use Cessatin Strategies Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient Diabetes Mellitus: Urine Screening fr Micralbumin r Medical Attentin fr Nephrpathy in Diabetic Patients Diabetes: Ft Exam Crnary Artery Disease (CAD): Lipid Cntrl 200* - Heart Failure: Warfarin Therapy Patients with Atrial Fibrillatin Ischemic Vascular Disease (IVD): Bld Pressure Management Cntrl Ischemic Vascular Disease (IVD): Use f Aspirin r Anther Antithrmbtic AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 15

16 305* - Initiatin and Engagement f Alchl and Other Drug Dependence Treatment: (a) Initiatin, (b) Engagement 306* - Prenatal Care: Screening fr Human Immundeficiency Virus (HIV) 307* - Prenatal Care: Anti-D Immune Glbulin 236* - Hypertensin: Cntrlling High Bld Pressure 309* - Cervical Cancer Screening 310* - Chlamydia Screening fr Wmen 311* - Use f Apprpriate Medicatins fr Asthma 312* - Lw Back Pain: Use f Imaging Studies 241 -Ischemic Vascular Disease (IVD): Cmplete Lipid Panel and Lw-Density (LDL-C) Cntrl 313* - Diabetes: Hemglbin A1c Cntrl (<8.0%) OTHER PHYSICIAN QUALITY REPORTING SYSTEM EHR MEASURES 39 - Screening r Therapy fr Osteprsis fr Wmen Aged 65 Years and Older 47 - Advance Care Plan 48 - Urinary Incntinence: Assessment f Presence r Absence f Urinary Incntinence in Wmen Aged 65 Years and Older Preventive Care and Screening: Unhealthy Alchl Use Screening 238* - Drugs t be Avided in the Elderly 316* - Preventive Care: Chlesterl-LDL test perfrmed Preventive Care and Screening: Bld Pressure Measurement * Measures are nt part f the PQRS Individual Measures Optin AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 16

17 ADDENDUM E 2012 PQRS REPORTING OPTIONS FOR MEASURES GROUPS DIABETES MELLITUS MEASURES GROUP: Intent Cde: G8485 Cmpsite Cde: G8494 CLAIMS, REGISTRY # 1. Diabetes Mellitus: Hemglbin A1c Pr Cntrl in Diabetes Mellitus # 2. Diabetes Mellitus: Lw Density Lipprtein (LDL-C) Cntrl in Diabetes Mellitus # 3. Diabetes Mellitus: High Bld Pressure Cntrl in Diabetes Mellitus #117. Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient #119. Diabetes Mellitus: Urine Screening fr Micralbumin r Medical Attentin fr Nephrpathy in Diabetic Patients #163. Diabetes Mellitus: Ft Exam ADULT KIDNEY DISEASE MEASURES GROUP: (Frmerly called (Chrnic Kidney Disease) Intent Cde: G8487 Cmpsite Cde: G8495 CLAIMS, REGISTRY #121. Chrnic Kidney Disease (CKD): Labratry Testing (Calcium, Phsphrus, Intact Parathyrid Hrmne (ipth) and Lipid Prfile) #122. Chrnic Kidney Disease (CKD): Bld Pressure Management #123. Chrnic Kidney Disease (CKD): Plan f Care: Elevated Hemglbin fr Patients Receiving Erythrpiesis - Stimulating Agents (ESA) #153.. Chrnic Kidney Disease (CKD): Referral fr Arterivenus (AV) Fistula #110.. Preventive Care and Screening: Influenza Immunizatin - NEW THE PREVENTIVE CARE MEASURES GROUP: Intent Cde: G8486 Cmpsite Cde: G8496 CLAIMS, REGISTRY # 39. Screening r Therapy fr Osteprsis fr Wmen Aged 65 Years and Older # 48. Urinary Incntinence: Assessment f Presence r Absence f Urinary Incntinence in Wmen Aged 65 Years and Older #110. Preventive Care and Screening: Influenza Immunizatin fr Patients 50 Years Old #111. Preventive Care and Screening: Pneumnia Vaccinatin fr Patients 65 years and Older #112. Preventive Care and Screening: Screening Mammgraphy #113. Preventive Care and Screening: Clrectal Cancer Screening #128. Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw-Up #173. Preventive Care and Screening: Unhealthy Alchl Use Screening #226. Preventive Care and Screening: Tbacc Use: Screening and Cessatin Interventin (new) CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: Intent Cde: G8544 Cmpsite Cde: G8497 REGISTRY ONLY # 43. Crnary Artery Bypass Graft (CABG): Use f Internal Mammary Artery (IMA) in Patients with Islated CABG Surgery # 44. Crnary Artery Bypass Graft (CABG): Preperative Beta-Blcker in Patients with Islated CABG Surgery #164. Crnary Artery Bypass Graft (CABG): Prlnged Intubatin (Ventilatin) #165. Crnary Artery Bypass Graft (CABG): Deep Sternal Wund Infectin Rate #166. Crnary Artery Bypass Graft (CABG): Strke/Cerebrvascular Accident (CVA) #167. Crnary Artery Bypass Graft (CABG): Pstperative Renal Insufficiency #168. Crnary Artery Bypass Graft (CABG): Surgical Re-explratin #169. Crnary Artery Bypass Graft (CABG): Anti-platelet Medicatins at Discharge #170. Crnary Artery Bypass Graft (CABG): Beta-Blckers Administered at Discharge #171. Crnary Artery Bypass Graft (CABG): Lipid Management and Cunseling AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 17

18 (cnt d) ADDENDUM E PQRS REPORTING OPTIONS FOR MEASURES GROUPS RHEUMATOID ARTHRITIS MEASURES GROUP: Intent Cde: G8490 Cmpsite Cde: G8499 CLAIMS, REGISTRY #108. Rheumatid Arthritis (RA): Disease Mdifying Anti-Rheumatic Drug (DMARD) Therapy #176. Rheumatid Arthritis (RA): Tuberculsis Screening #177. Rheumatid Arthritis (RA): Peridic Assessment f Disease Activity #178. Rheumatid Arthritis (RA): Functinal Status Assessment #179. Rheumatid Arthritis (RA): Assessment and Classificatin f Disease Prgnsis #180. Rheumatid Arthritis (RA): Gluccrticid Management PERIOPERATIVE CARE MEASURES GROUP: Intent Cde: G8492 Cmpsite Cde: G8501 CLAIMS, REGISTRY #20. Periperative Care: Timing f Antibitic Prphylaxis Ordering Physician #21. Periperative Care: Selectin f Prphylactic Antibitic First OR Secnd Generatin Cephalsprin #22. Periperative Care: Discntinuatin f Prphylactic Antibitics (Nn-Cardiac Prcedures) #23. Periperative Care: Venus Thrmbemblism (VTE) Prphylaxis (When Indicated in ALL Patients). BACK PAIN MEASURES GROUP: Intent Cde: G8493 Cmpsite Cde: G8502 CLAIMS, REGISTRY #148. Back Pain: Initial Visit #149. Back Pain: Physical Exam #150. Back Pain: Advice fr Nrmal Activities #151. Back Pain: Advice Against Bed Rest HEPATITIS C MEASURES GROUP: Intent Cde: G8545 Cmpsite Cde: G8549 CLAIMS, REGISTRY # 84. Hepatitis C: Ribnucleic Acid (RNA) Testing Befre Initiating Treatment # 85. Hepatitis C: HCV Gentype Testing Prir t Treatment # 86. Hepatitis C: Antiviral Treatment Prescribed # 87. Hepatitis C: HCV Ribnucleic Acid (RNA) Testing at Week 12 f Treatment # 89. Hepatitis C: Cunseling Regarding Risk f Alchl Cnsumptin # 90. Hepatitis C: Cunseling Regarding Use f Cntraceptin Prir t Antiviral Therapy #183. Hepatitis C: Hepatitis A Vaccinatin in Patients with HCV #184. Hepatitis C: Hepatitis B Vaccinatin in Patients with HCV HEART FAILURE (HF) MEASURES GROUP: Intent Cde: G8548 Cmpsite Cde: G8551 REGISTRY ONLY # 5. Heart Failure: Angitensin-Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) # 8. Heart Failure: Beta-Blcker Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) # 198. Heart Failure: Left Ventricular Functin (LVF) Assessment # 199. Heart Failure: Patient Educatin #226. Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin CORONARY ARTERY DISEASE (CAD) MEASURES GROUP: Intent Cde: G8489 Cmpsite Cde: G8498 REGISTRY ONLY # 6. Crnary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed fr Patients with CAD # 196. Crnary Artery Disease (CAD): Symptm and Activity Assessment # 197. Crnary Artery Disease (CAD): Drug Therapy fr Lwering LDL-Chlesterl #226. Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 18

19 ADDENDUM E PQRS REPORTING OPTIONS FOR MEASURES GROUPS (cnt d) ISCHEMIC VASCULAR DISEASE (IVD) MEASURES GROUP: Intent Cde: G8547 Cmpsite Cde: G8552 CLAIMS, REGISTRY #114. Inquiry Regarding Tbacc Use (Preventive Care and Screening) #115. Advising Smkers and Tbacc Users t Quit (Preventive Care and Screening) #201. Ischemic Vascular Disease (IVD): Bld Pressure Management Cntrl #202. Ischemic Vascular Disease (IVD): Cmplete Lipid Prfile #203. Ischemic Vascular Disease (IVD): Lw Density Lipprtein (LDL-C) Cntrl #204. Ischemic Vascular Disease (IVD): Use f Aspirin r Anther Antithrmbtic #226. Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin HIV/AIDS MEASURES GROUP: Intent Cde: G8491 Cmpsite Cde: G8500 REGISTRY ONLY # 159. HIV/AIDS: CD4+ Cell Cunt r CD4+ Percentage # 160. HIV/AIDS: Pneumcystis Jirveci Pneumnia (PCP) Prphylaxis # 161. HIV/AIDS: Adlescent and Adult Patients with HIV/AIDS Wh Are Prescribed Ptent Antiretrviral Therapy # 162. HIV/AIDS: HIV RNA Cntrl After Six Mnths f Ptent Antiretrviral Therapy # 205. HIV/AIDS: Sexually Transmitted Diseases Chlamydia and Gnrrhea Screenings # 206. HIV/AIDS: Screening fr High Risk Sexual Behavirs # 207. HIV/AIDS: Screening fr Injectin Drug Use # 208. HIV/AIDS: Sexually Transmitted Diseases Syphilis Screening COMMUNITY ACQUIRED PNEUMONIA (CAP) MEASURES GROUP: Intent Cde: G8546 Cmpsite Cde: G8550 CLAIMS, REGISTRY #56. Cmmunity-Acquired Pneumnia (CAP): Vital Signs #57. Cmmunity-Acquired Pneumnia (CAP): Assessment f Oxygen #58. Cmmunity-Acquired Pneumnia (CAP): Assessment f Mental Status #59. Cmmunity-Acquired Pneumnia (CAP): Empiric Antibitic ASTHMA MEASURES GROUP Intent Cde: G8645 Cmpsite Cde: G8646 CLAIMS, REGISTRY #53. Asthma: Pharmaclgic Therapy #64. Asthma: Asthma Assessment #231. Asthma: Tbacc Use: Screening Ambulatry Care Setting #232. Asthma: Tbacc Use: Interventin Ambulatry Care Setting COPD MEASURES GROUP Intent Cde: G8898 Cmpsite Cde: CLAIMS, REGISTRY #110. Preventive Care and Screening: Influenza Immunizatin #111. Preventive Care and Screening: Pneumnia Vaccinatin fr Patients 65 years and Older #51. Chrnic Obstructive Pulmnary Disease (COPD); Spirmetry Evaluatin #52. Chrnic Obstructive Pulmnary Disease (COPD); Brnchdilatr Therapy #226. Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin INFLAMATORY BOWEL DISEASE (IBD) MEASURES GROUP Intent Cde: G8899 Cmpsite Cde REGISTRY ONLY #269. IBD: Type, Anatmic Lcatin and Activity All Dcumented #270: IBD: Preventive Care: Sterid Sparing Therapy #271: IBD: Preventive Care: Sterid Related Iatrgenic Injury-Bne Lss Assessment #272. IBD: Preventive Care: Influenza Immunizatin #273: IBD: Preventive Care: Pneumcccal Immunizatin #274. IBD: Screening fr Latent TB Befre Initiating Anti-TNF Therapy #275. IBD: Hepatitis B Assessment Befre Initiating Anti-TNF Therapy #226. IBD: Preventive Care: Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 19

20 (cnt d) ADDENDUM E PQRS REPORTING OPTIONS FOR MEASURES GROUPS SLEEP APNEA MEASURES GROUP Intent Cde: G8900 Cmpsite Cde REGISTRY ONLY #276. Assessment f Sleep Symptms #277: Severity Assessment at Initial Diagnsis #278: Psitive airway Pressure Therapy Prescribed #279: Assessment f Adherence t Psitive Airway Pressure Therapy DEMENTIAL MEASURES GROUP Intent Cde: G8902 Cmpsite Cde REGISTRY ONLY #280. Dementia: Staging f Dementia #281. Dementia: Cgnitive Assessment #282. Dementia: Functinal Status Assessment #283: Dementia: Neurpsychiatric Symptm Assessment #284. Dementia: Management f Neurpsychiatric Symptms #285. Dementia: Screening fr Depressive Symptms #286. Dementia: Cunseling Regarding Safety Cncerns #287 Dementia: Cunseling Regarding Risks f Driving #288. Dementia: Caregiver Educatin and Supprt PARKINSON S MEASURES GROUP REGISTRY ONLY Intent Cde:G8903 Cmpsite Cde #289. Annual Parkinsn s Disease Diagnsis Review #290. Psychiatric Disrders r Disturbances Assessment #291. Cgnitive Impairment f Dysfunctin Assessment #292. Querying abut Sleep Disturbances #293. Parkinsn s Disease Rehabilitative Therapy Optins #294. Parkinsn s Disease Medical and Surgical Treatment Optins Reviewed HYPERTENSION MEASURES GROUP Intent Cde:G8904 Cmpsite Cde #295. Aspirin r Other Anti-Platelet r anti-cagulant Therapy #296. Cmplete Lipid Prfile #297. Urine Prtein Test #298. Annual Serum Creatinine Test #299. Diabetes Dcumentatin r Screen Test #300. Bld Pressure Cntrl #301. LDL Cntrl #302. Cunseling fr Diet and Physical Activity l REGISTRY ONLY CARDIOVASCULR PREVENTION MEASURES GROUP CLAIMS, REGISTRY Intent Cde: Cmpsite Cde #2. Diabetes Mellitus: Lw Density Lipprtein (LDL-C) Cntrl in Diabetes Mellitus #204. Ischemic Vascular Disease (IVD): Use f Aspirin r anther Antithrmbtic #226. Measure pair: a. Tbacc Use Assessment, b. Tbacc Cessatin Interventin #236. Cntrlling High Bld Pressure #241: Ischemic Vascular Disease (IVD): Cmplete Lipid Prfile and LDL Cntrl <100 #317. Preventive Care and Screening; Bld Pressure Measurement CATARACTS MEASURES GROUP REGISTRY ONLY Intent Cde: G8906 Cmpsite Cde: #191. Cataracts: 20/40 r Better Visual Acuity within 90 Days Fllwing Cataract Surgery #192. Cataracts: Cmplicatins within 30 Days Fllwing Cataract Surgery Requiring Additinal Surgical Prcedures #303. Cataracts: Imprvement in Patient s Visual Functin within 90 Days Fllwing Cataract Surgery #304. Cataracts: Patient Satisfactin within 90 Days Fllwing Cataract Surgery AdvantEdge Healthcare Slutins infrmatin@ahsrcm.cm 20