2018 CMS Web Interface

Size: px
Start display at page:

Download "2018 CMS Web Interface"

Transcription

1 CMS Web Interface Diabetes Mellitus (DM) Cmpsite (All r Nthing Scring) DM-2 (NQF 0059): Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) DM-7 (NQF Measure Steward: NCQA CMS Web Interface V2.1 Page 1 f 26 06/25/

2 Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION... 5 BENEFICIARY SAMPLING... 5 NARRATIVE MEASURE SPECIFICATION... 6 DM-2: DIABETES: HEMOGLOBIN A1C (HBA1C) POOR CONTROL (>9%)... 6 DESCRIPTION:... 6 IMPROVEMENT NOTATION:... 6 INITIAL POPULATION:... 6 DENOMINATOR:... 6 DENOMINATOR EXCLUSIONS:... 6 DENOMINATOR EXCEPTIONS:... 6 NUMERATOR:... 6 NUMERATOR EXCLUSIONS:... 6 DEFINITIONS:... 6 GUIDANCE:... 6 NARRATIVE MEASURE SPECIFICATION... 7 DM-7: DIABETES: EYE EXAM... 7 DESCRIPTION:... 7 IMPROVEMENT NOTATION:... 7 INITIAL POPULATION:... 7 DENOMINATOR:... 7 DENOMINATOR EXCLUSIONS:... 7 DENOMINATOR EXCEPTIONS:... 7 NUMERATOR:... 7 NUMERATOR EXCLUSIONS:... 7 DEFINITIONS:... 7 GUIDANCE:... 7 SUBMISSION GUIDANCE... 8 PATIENT CONFIRMATION... 8 SUBMISSION GUIDANCE... 9 COMPOSITE CONFIRMATION... 9 SUBMISSION GUIDANCE NUMERATOR REPORTING CMS Web Interface V2.1 Page 2 f 26 06/25/

3 DM-2: Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) SUBMISSION GUIDANCE NUMERATOR REPORTING DM-7: Diabetes: Eye Exam DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT CMS Web Interface V2.1 Page 3 f 26 06/25/

4 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The measure dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each measure dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. CMS Web Interface V2.1 Page 4 f 26 06/25/

5 CMS WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the CMS Web Interface Sampling Dcument, which will be made available during the perfrmance year at CMS.gv. CMS Web Interface V2.1 Page 5 f 26 06/25/

6 NARRATIVE MEASURE SPECIFICATION DM-2: Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) DESCRIPTION: Percentage f patients years f age with diabetes wh had hemglbin A1c > 9.0% during the measurement perid IMPROVEMENT NOTATION: Lwer scre indicates better quality INITIAL POPULATION: Patients years f age with diabetes with a visit during the measurement perid DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Nne DENOMINATOR EXCEPTIONS: Nne NUMERATOR: Patients whse mst recent HbA1c level (perfrmed during the measurement perid) is > 9.0% DEFINITIONS: Nne NUMERATOR EXCLUSIONS: Nt Applicable GUIDANCE: Patient is numeratr cmpliant if mst recent HbA1c level is > 9%, the mst recent HbA1c result is missing, r if there are n HbA1c tests perfrmed and results dcumented during the measurement perid. If the HbA1c test result is in the medical recrd, the test can be used t determine numeratr cmpliance. Only patients with a diagnsis f Type 1 r Type 2 diabetes shuld be included in the denminatr f this measure; patients with a diagnsis f secndary diabetes due t anther cnditin shuld nt be included. CMS Web Interface V2.1 Page 6 f 26 06/25/

7 NARRATIVE MEASURE SPECIFICATION DM-7: Diabetes: Eye Exam DESCRIPTION: Percentage f patients years f age with diabetes wh had a retinal r dilated eye exam by an eye care prfessinal during the measurement perid r a negative retinal exam (n evidence f retinpathy) in the 12 mnths prir t the measurement perid IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: Patients years f age with diabetes with a visit during the measurement perid DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Nne DENOMINATOR EXCEPTIONS: Nne NUMERATOR: Patients with an eye screening fr diabetic retinal disease. This includes diabetics wh had ne f the fllwing: A retinal r dilated eye exam by an eye care prfessinal in the measurement perid r a negative retinal exam (n evidence f retinpathy) by an eye care prfessinal in the year prir t the measurement perid DEFINITIONS: Nne NUMERATOR EXCLUSIONS: Nt Applicable GUIDANCE: Only patients with a diagnsis f Type 1 r Type 2 diabetes shuld be included in the denminatr f this measure; patients with a diagnsis f secndary diabetes due t anther cnditin shuld nt be included. The eye exam must be perfrmed by an phthalmlgist r ptmetrist. CMS Web Interface V2.1 Page 7 f 26 06/25/

8 SUBMISSION GUIDANCE PATIENT CONFIRMATION Establishing patient eligibility fr reprting requires the fllwing: Guidance Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry r did nt have Feefr-Service (FFS) Medicare as their primary payer select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The CMS Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have been sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - Nn-FFS Medicare: Select this ptin if the patient was enrlled in Nn-FFS Medicare at any time during the measurement perid (i.e., cmmercial payers, Medicare Advantage, Nn-FFS Medicare, HMOs, etc.) This exclusin is intended t remve beneficiaries fr whm Fee-fr-Service Medicare is nt the primary payer. CMS Web Interface V2.1 Page 8 f 26 06/25/

9 COMPOSITE CONFIRMATION SUBMISSION GUIDANCE Determine if the patient has a dcumented histry OR active diagnsis f diabetes during the measurement perid r year prir t the measurement perid OR OR If the patient has a dcumented histry f DM in the medical recrd select Yes If yu are unable t cnfirm the diagnsis f DM fr the patient select Nt Cnfirmed - Diagnsis If there is an ther CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr cdes can be fund in the CMS Web Interface DM Cmpsite Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Nt Cnfirmed Diagnsis r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be reprted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all CMS Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure and reasn fr request in a Quality Payment Prgram Service Desk inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. The patient will be skipped and anther patient must be reprted in their place, if available. NOTE: - Active Diagnsis is defined as a diagnsis that is either n the patient s prblem list, a diagnsis cde listed n the encunter, r is dcumented in a prgress nte indicating that the patient is being treated r managed fr the disease r cnditin during the measurement perid CMS Web Interface V2.1 Page 9 f 26 06/25/

10 NUMERATOR SUBMISSION SUBMISSION GUIDANCE DM-2: Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) Determine if the patient had ne r mre HbA1c tests perfrmed during the measurement perid OR If the patient did nt have ne r mre HbA1c tests dcumented select N If the patient had ne r mre HbA1c tests dcumented select Yes AND If yes, recrd the mst recent date the bld was drawn fr the HbA1c in MM/DD/YYYY frmat If yes, recrd the mst recent HbA1c value OR if test was perfrmed but result is nt dcumented, recrd "0" (zer) value Numeratr cdes can be fund in the CMS Web Interface DM Cmpsite Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr If N is selected, d nt prvide Date Drawn and HbA1c Value. NOTE: - Synnyms fr HbA1c testing may include Glychemglbin A1c, HbA1c, Hemglbin A1c, HgbA1c, A1c - Use the fllwing pririty ranking: Lab reprt draw date Lab reprt date Flw sheet dcumentatin Practitiner ntes Other dcumentatin - Patient Reprted Requirement: Date and mst recent value (distinct value required) - Ranges and threshlds d nt meet criteria fr this indicatr. A distinct numeric result is required fr numeratr cmpliance - At a minimum, dcumentatin in the medical recrd must include a nte indicating the date n which the HbA1c test was perfrmed and the result. If the day is unknwn enter 01 i.e. 05/01/ - Dcumentatin f mst recent HbA1c result may be cmpleted during a telehealth encunter - HbA1c finger stick tests administered by a healthcare prvider at the pint f care are allwed CMS Web Interface V2.1 Page 10 f 26 06/25/

11 NUMERATOR SUBMISSION DM-7: Diabetes: Eye Exam SUBMISSION GUIDANCE Determine if patient was screened fr diabetic retinal disease identified by ne f the fllwing: A retinal r dilated eye exam by an eye care prfessinal during the measurement perid OR a negative retinal exam (n evidence f retinpathy) by an eye care prfessinal in the year prir t the measurement perid OR If the patient was nt screened fr diabetic retinal disease select N If the patient was screened fr diabetic retinal disease select Yes Numeratr cdes can be fund in the CMS Web Interface DM Cmpsite Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr NOTE: - Patient Reprted Requirement: Date (year) and result/finding - If an endcrinlgist r PCP perfrms the apprpriate imaging in their ffice and the results are reviewed by an eye care prfessinal (ptmetrist r phthalmlgist) during the measurement perid r the year prir t the measurement perid (if negative fr retinpathy) then it is eligible fr use in reprting - If the eye exam is nt perfrmed r reviewed by an phthalmlgist r ptmetrist, results may be read by a qualified reading center that perates under the directin f a medical directr wh is a retinal specialist - Use f retinal imaging is acceptable as lng as it includes the date when the fundus phtgraphy was perfrmed and evidence that an eye care prfessinal reviewed the results - Dcumentatin f diabetic retinal disease screening may be cmpleted during a telehealth encunter CMS Web Interface V2.1 Page 11 f 26 06/25/

12 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the CMS Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Claims data cannt be used t cnfirm a diagnsis (DM, IVD, HTN, etc.,) used fr sampling purpses as claims are the riginal surce f the diagnsis sampling. Claims data can be used t prepare the CMS Web Interface Excel, but supprting medical recrd dcumentatin will be required t substantiate what is reprted in the event f an audit. CMS Web Interface V2.1 Page 12 f 26 06/25/

13 Appendix I: Perfrmance Calculatin Flw CMS Web Interface V2.1 Page 13 f 26 06/25/

14 CMS Web Interface V2.1 Page 14 f 26 06/25/

15 CMS Web Interface V2.1 Page 15 f 26 06/25/

16 CMS Web Interface V2.1 Page 16 f 26 06/25/

17 CMS Web Interface V2.1 Page 17 f 26 06/25/

18 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r Nn-FFS Medicare, will nly need t be dne nce per patient. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, Nn-FFS Medicare. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr Diabetes. CMS Web Interface V2.1 Page 18 f 26 06/25/

19 Measure Cnfirmatin Flw fr Diabetes Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr Diabetes. Cmplete fr cnsecutively ranked patients aged 18 t 75 years at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the DM cmpsite. If this is the case, the system will autmatically remve the patient frm the cmpsite requirements. 2. Check t determine if the patient has a dcumented histry r active diagnsis f diabetes during the measurement perid r year prir t the measurement perid. a. If n, the patient des nt have a dcumented histry f diabetes during the measurement perid r year prir t the measurement perid, mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this cmpsite. The patient will be skipped and replaced. Stp prcessing b. If yes, the patient des have a dcumented histry f diabetes during the measurement perid r year prir t the measurement perid, cntinue prcessing. 3. Check t determine if the patient qualifies fr the cmpsite (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the cmpsite select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this cmpsite. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv. Stp prcessing. b. If yes, the patient des qualify fr the cmpsite, cntinue t DM-2 measure flw. CMS Web Interface V2.1 Page 19 f 26 06/25/

20 Measure Flw fr DM-2 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the DM Cding Dcument. 1. Start prcessing DM-2 (NQF 0059) Flw fr the patients that qualified fr the sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr Diabetes. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 210 patients). 2. Check t determine if the patient had ne r mre HbA1c tests perfrmed during the measurement perid. a. If n, patient did nt have ne r mre HbA1c tests perfrmed during the measurement perid, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a¹ categry (numeratr, i.e. 40 patients). Stp prcessing. b. If yes, the patient had ne r mre HbA1c tests perfrmed during the measurement perid, recrd the mst recent date the bld was drawn fr the HbA1c in MM/DD/YYYY frmat and the mst recent HbA1c value OR if test was perfrmed but result is nt dcumented, recrd 0 (zer) value. Cntinue prcessing. 3. Check t determine if the patient s mst recent HbA1c value was greater than nine percent r equal t zer percent. a. If n, patient s mst recent HbA1c value was nt greater than nine percent r equal t zer percent, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, patient s mst recent HbA1c value was greater than nine percent r equal t zer percent, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a² categry (numeratr, i.e. 40 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a¹ plus a² in the measure flw (80 patients) Denminatr is categry d in measure flw (210 patients) 80 (Perfrmance Met) divided by 210 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met Fr this Measure, a Lwer Rate Indicates Better Perfrmance/Cntrl CMS Web Interface V2.1 Page 20 f 26 06/25/

21 Measure Flw fr DM-7 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the DM Cding Dcument. 1. Start prcessing DM-7 (NQF 0055) Flw fr the patients that qualified fr the sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr Diabetes. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 210 patients). 2. Check t determine if the patient was screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was dcumented in the year prir t the measurement perid. a. If n, the patient was nt screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was nt dcumented in the year prir t the measurement perid, perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient was screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was dcumented in the year prir t the measurement perid, perfrmance is met and the patient shuld be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a categry (numeratr, i.e. 180 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (180 patients) Denminatr is categry d in measure flw (210 patients) 180 (Perfrmance Met) divided by 210 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.1 Page 21 f 26 06/25/

22 Measure Flw Diabetes Cmpsite The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the DM Cding Dcument. 1. Start prcessing Diabetes Cmpsite Measure Flw fr the patients that qualified fr sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr Diabetes. Nte: Include remainder f patients listed in the CMS Web Interface that were cnsecutively cnfirmed and cmpleted fr the cmpnents within this denminatr fr the cmpsite measure. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 210 patients). 2. Check t determine if the patient had ne r mre HbA1c tests during the measurement perid (DM-2). a. If n, the patient did nt have ne r mre HbA1c tests during the measurement perid, the patient fails the cmpsite measure. Stp prcessing cmpsite measure. b. If yes, the patient did have ne r mre HbA1c tests during the measurement perid, recrd the mst recent date the bld was drawn fr the HbA1c in MM/DD/YYYY frmat and the mst recent HbA1c value OR if test was perfrmed but result is nt dcumented, recrd 0 (zer) value. Cntinue prcessing. 3. Check t determine if the patient s mst recent HbA1c value was greater than nine percent r equal t zer percent. a. If n, the patient s mst recent HbA1c value was nt greater than nine percent r equal t zer percent, the patient passes 1 f the 2 cmpnents f the Diabetes cmpsite measure. Cntinue prcessing fr DM-7. b. If yes, the patient s mst recent HbA1c value was greater than nine percent r equal t zer percent, the patient fails 1 f the 2 cmpnents f the Diabetes cmpsite measure. Stp prcessing cmpsite measure. 4. Check t determine if the patient was screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was dcumented in the year prir t the measurement perid (DM-7). a. If n, the patient was nt screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was nt dcumented in the year prir t the measurement perid, the patient fails 1 f 2 cmpnents f the Diabetes cmpsite measure. Stp prcessing cmpsite measure. b. If yes, the patient was screened fr diabetic retinal disease during the measurement perid OR a negative retinal exam was dcumented in the year prir t the measurement perid, the patient passes 1 f 2 cmpnents f the Diabetes cmpsite measure. Cntinue prcessing. 5. Determine if the patient passed DM-2 and DM-7 cmpnents f the cmpsite measure. If the patient passed bth cmpnents, the patient meets the cmpsite measure. Fr the sample calculatin in the flw these patients wuld fall int the a categry (numeratr, i.e. 190 patients). Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (190 patients) Denminatr is categry d in measure flw (210 patients) 190 (Perfrmance Met) divided by 210 (Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.1 Page 22 f 26 06/25/

23 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the CMS Web Interface DM Cding Dcument. *DM Cmpsite ( All r Nthing Scring) Measure Cmpnent/Excel Tab Data Element Variable Name Cding System(s) Denminatr/Denminatr Cdes Diabetes Diagnsis DM_DX_CODE I9 I10 SNM Numeratr/Numeratr Cdes Hemglbin A1c (DM-2) A1C_CODE Eye Exam EYE_EXAM_CODE (DM-7) NEGATIVE_FINDING_CODE *Fr EHR mapping, the cding within the DM Cmpsite is cnsidered t be all inclusive LN WITH mst recent A1c date and value SNM SNM CMS Web Interface V2.1 Page 23 f 26 06/25/

24 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: DM-2: Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) As the seventh leading cause f death in the U.S., diabetes kills apprximately 75,000 peple a year (CDC FastStats 2015). Diabetes is a grup f diseases marked by high bld glucse levels, resulting frm the bdy's inability t prduce r use insulin (CDC Statistics 2014, ADA Basics 2013). Peple with diabetes are at increased risk f serius health cmplicatins including visin lss, heart disease, strke, kidney failure, amputatin f tes, feet r legs, and premature death. (CDC Fact Sheet 2014). In 2012, diabetes cst the U.S. an estimated $245 billin: $176 billin in direct medical csts and $69 billin in reduced prductivity. This is a 41 percent increase frm the estimated $174 billin spent n diabetes in 2007 (ADA Ecnmic 2013). Reducing A1c bld level results by 1 percentage pint (eg, frm 8.0 percent t 7.0 percent) helps reduce the risk f micrvascular cmplicatins (eye, kidney and nerve diseases) by as much as 40 percent (CDC Estimates 2011). DM-7: Diabetes: Eye Exam As the seventh leading cause f death in the U.S., diabetes kills apprximately 75,000 peple a year (CDC FastStats 2015). Diabetes is a grup f diseases marked by high bld glucse levels, resulting frm the bdy's inability t prduce r use insulin (CDC Statistics 2014, ADA Basics 2013). Peple with diabetes are at increased risk f serius health cmplicatins including visin lss, heart disease, strke, kidney failure, amputatin f tes, feet r legs, and premature death. (CDC Fact Sheet 2014). In 2012, diabetes cst the U.S. an estimated $245 billin: $176 billin in direct medical csts and $69 billin in reduced prductivity. This is a 41 percent increase frm the estimated $174 billin spent n diabetes in 2007 (ADA Ecnmic 2013). In , f adults with diabetes aged 40 years r lder, 4.2 millin (28.5%) peple had diabetic retinpathy, damage t the small bld vessels in the retina that may result in lss f visin. (CDC Statistics, 2014). CLINICAL RECOMMENDATION STATEMENTS: DM-2: Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) American Diabetes Assciatin (2017): - A reasnable A1C gal fr many nnpregnant adults is <7%. (Level f evidence: A) - Prviders might reasnably suggest mre stringent A1C gals (such as <6.5%) fr selected individual patients if this can be achieved withut significant hypglycemia r ther adverse effects f treatment. Apprpriate patients might include thse with shrt duratin f diabetes, type 2 diabetes treated with lifestyle r metfrmin nly, lng life expectancy, r n significant cardivascular disease (CVD). (Level f evidence: C) - Less stringent A1C gals (such as <8%) may be apprpriate fr patients with a histry f severe hypglycemia, limited life expectancy, advanced micrvascular r macrvascular cmplicatins, extensive cmrbid cnditins, r lng-standing diabetes in whm the general gal is difficult t attain despite diabetes self-management educatin, apprpriate glucse mnitring, and effective dses f multiple glucse-lwering agents including insulin. (Level f evidence: B) DM-7: Diabetes: Eye Exam American Diabetes Assciatin (ADA) (2017): - Adults with type 1 diabetes shuld have an initial dilated and cmprehensive eye examinatin by an phthalmlgist r ptmetrist within 5 years after the nset f diabetes. (Level f evidence: B) CMS Web Interface V2.1 Page 24 f 26 06/25/

25 - Patients with type 2 diabetes shuld have an initial dilated and cmprehensive eye examinatin by an phthalmlgist r ptmetrist at the time f the diagnsis f diabetes. (Level f evidence: B) CMS Web Interface V2.1 Page 25 f 26 06/25/

26 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT The measures and specificatins were develped by and are wned by the Natinal Cmmittee fr Quality Assurance ( NCQA ). NCQA hlds a cpyright in the measures and specificatins and may rescind r alter these measures and specificatins at any time. Users f the measures and specificatins shall nt have the right t alter, enhance r therwise mdify the measures and specificatins, and shall nt disassemble, recmpile r reverse engineer the measures and specificatins. Anyne desiring t use r reprduce the materials withut mdificatin fr a nn-cmmercial purpse may d s withut btaining any apprval frm NCQA. All cmmercial uses r requests fr alteratin f the measures and specificatins must be apprved by NCQA and are subject t a license at the discretin f NCQA. The measures and specificatins are nt clinical guidelines, d nt establish a standard f medical care and have nt been tested fr all ptential applicatins. The measures and specificatins are prvided as is withut warranty f any kind. NCQA makes n representatins, warranties r endrsements abut the quality f any prduct, test r prtcl identified as numeratr cmpliant r therwise identified as meeting the requirements f a measure r specificatin. NCQA als makes n representatins, warranties r endrsements abut the quality f any rganizatin r clinician wh uses r reprts perfrmance measures. NCQA has n liability t anyne wh relies n measures and specificatins r data reflective f perfrmance under such measures and specificatins Natinal Cmmittee fr Quality Assurance, all rights reserved. Perfrmance measures develped by NCQA fr CMS may lk different frm the measures slely created and wned by NCQA. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. NCQA disclaims all liability fr use r accuracy f any cding cntained in the specificatins. The American Medical Assciatin hlds a cpyright t the CPT cdes cntained in the measures specificatins. CMS Web Interface V2.1 Page 26 f 26 06/25/

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface Diabetes Mellitus (DM) Cmpsite (All r Nthing Scring) DM-2 (NQF 0059): Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) DM-7 (NQF 0055): Diabetes: Eye Exam Measure Steward: NCQA Web Interface

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface PREV-6 (NQF 0034): Clrectal Cancer Screening Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface PREV-5 (NQF 2372): Breast Cancer Screening Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface HTN-2 (NQF 0018): Cntrlling High Bld Pressure Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 18 11/13/2017 Cntents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface CARE-2 (NQF 0101): Falls: Screening fr Future Fall Risk Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION...

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface IVD-2 (NQF 0068): Ischemic Vascular Disease (IVD): Use f Aspirin r Anther Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 20 11/13/2017 Cntents INTRODUCTION... 3 CMS WEB INTERFACE

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface MH-1 (NQF 0710): Depressin Remissin at Twelve Mnths Measure Steward: MNCM CMS Web Interface V2.0 Page 1 f 27 11/13/2017 Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION...

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface MH-1 (NQF 0710): Depressin Remissin at Twelve Mnths Measure Steward: MNCM CMS Web Interface V2.1 Page 1 f 27 06/25/ Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION...

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-12 (NQF 0418): Preventive Care and Screening: Screening fr Depressin and Measure Steward: CMS CMS Web Interface V2.1 Page 1 f 23 06/25/ Cntents INTRODUCTION... 3 CMS WEB INTERFACE

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface PREV-12 (NQF 0418): Preventive Care and Screening: Screening fr Depressin and Fllw-Up Measure Steward: CMS Web Interface V1.0 Page 1 f 22 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE

More information

2018 CMS Web Interface

2018 CMS Web Interface PREV-13: Statin Therapy fr the Preventin and Treatment f Cardivascular Disease CMS Web Interface PREV-13: Statin Therapy fr the Preventin and Treatment f Cardivascular Disease Measure Steward: CMS CMS

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-13: Statin Therapy fr the Preventin and Treatment f Cardivascular Disease Measure Steward: CMS CMS Web Interface V2.1 Page 1 f 27 06/25/ Cntents INTRODUCTION... 4 CMS WEB INTERFACE

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-9 (NQF 0421): Preventive Care and Screening: Bdy Mass Index (BMI) Screening Measure Steward: CMS CMS Web Interface V2.0 Page 1 f 23 11/13/2017 Cntents INTRODUCTION... 3 CMS WEB INTERFACE

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface PREV-13: Statin Therapy fr the Preventin and Treatment f Cardivascular Disease Measure Steward: CMS Web Interface V1.1 Page 1 f 27 12/15/2016 Cntents INTRODUCTION... 4 WEB INTERFACE SAMPLING

More information

2017 CMS Web Interface

2017 CMS Web Interface CMS Web Interface PREV-9 (NQF 0421): Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw- Measure Steward: CMS Web Interface V1.0 Page 1 f 23 11/15/2016 Cntents INTRODUCTION... 3 WEB

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-9 (NQF 0421): Preventive Care and Screening: Bdy Mass Index (BMI) Screening Measure Steward: CMS CMS Web Interface V2.1 Page 1 f 24 06/25/ Cntents INTRODUCTION... 3 CMS WEB INTERFACE

More information

Diabetes: HbA1c Poor Control (NQF 0059)

Diabetes: HbA1c Poor Control (NQF 0059) Diabetes: HbA1c Pr Cntrl (NQF 0059) EMeasure Name Diabetes: HbA1c Pr Cntrl EMeasure Id Pending Versin Number 1 Set Id Pending Available Date N infrmatin Measurement January 1, 20xx thrugh Perid December

More information

Measure Specific Guidelines for Comprehensive Diabetes Care (CDC)

Measure Specific Guidelines for Comprehensive Diabetes Care (CDC) Measure Specific Guidelines fr Cmprehensive Diabetes Care (CDC) Descriptin: Members age 18-75 years f age with diabetes (Type 1 and Type 2)* that had all f the fllwing: *Members in hspice are excluded

More information

Weight Assessment and Counseling for Children and Adolescents (NQF 0024)

Weight Assessment and Counseling for Children and Adolescents (NQF 0024) Weight Assessment and Cunseling fr Children and Adlescents (NQF 0024) EMeasure Name Weight Assessment and EMeasure Id Pending Cunseling fr Children and Adlescents Versin Number 1 Set Id Pending Available

More information

Obesity/Morbid Obesity/BMI

Obesity/Morbid Obesity/BMI Obesity/mrbid besity/bdy mass index (adult) Obesity/Mrbid Obesity/BMI Definitins and backgrund Diagnsis cde assignment is based n the prvider s clinical judgment and crrespnding medical recrd dcumentatin

More information

LTCH QUALITY REPORTING PROGRAM

LTCH QUALITY REPORTING PROGRAM 4 LTCH QUALITY REPORTING PROGRAM GENERAL INFORMATION...3 LTCH FACILITY-LEVEL QUALITY MEASURE REPORT...5 LTCH PATIENT-LEVEL QUALITY MEASURE REPORT...18 LTCH REVIEW AND CORRECT REPORT...23 09/2018 v1.04

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-5 (NQF 2372): Breast Cancer Screening Measure Steward: NCQA CMS Web Interface V2.1 Page 1 of 18 06/25/ Contents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY

More information

CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services Information posted November 10, 2009

CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services Information posted November 10, 2009 CSHCN Services Prgram Benefits t Change fr Outpatient Behaviral Health Services Infrmatin psted Nvember 10, 2009 Effective fr dates f service n r after January 1, 2010, benefit criteria fr utpatient behaviral

More information

2019 CMS Web Interface

2019 CMS Web Interface CMS Web Interface PREV-5 (NQF 2372): Breast Cancer Screening Measure Steward: NCQA CMS Web Interface V3.0 Page 1 of 18 xx/xx/2018 Contents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

Childhood Immunization Status (NQF 0038)

Childhood Immunization Status (NQF 0038) Childhd Immunizatin Status (NQF 0038) EMeasure Name Childhd Immunizatin EMeasure Id Pending Status Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December

More information

Bariatric Surgery FAQs for Employees in the GRMC Group Health Plan

Bariatric Surgery FAQs for Employees in the GRMC Group Health Plan Bariatric Surgery FAQs fr Emplyees in the GRMC Grup Health Plan Gergia Regents Medical Center and Gergia Regents Medical Assciates emplyees and eligible dependents wh are in the GRMC Grup Health Plan (Select

More information

MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache

MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache Measure Descriptin All patients diagnsed with migraine headache r cervicgenic headache wh had a headache management

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-8: Pneumococcal Vaccination Status for Older AdultsMeasure Steward: NCQA CMS Web Interface V2.1 Page 1 of 18 06/25/ Contents INTRODUCTION...3 CMS WEB INTERFACE SAMPLING INFORMATION...4

More information

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10 Pdcast Transcript Title: Cmmn Miscding f LARC Services Impacting Revenue Speaker Name: Ann Finn Duratin: 00:16:10 NCTCFP: Welcme t this pdcast spnsred by the Natinal Clinical Training Center fr Family

More information

Coding. Training Guide

Coding. Training Guide Cding (Specialty Hspital) Visin 4.3 (January 2013) Training Guide SurceMedical VisinSH Cding Learning Center f Excellence Last change made: January 2013 2013 Surce Medical Slutins, Inc. All Rights Reserved.

More information

Continuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator

Continuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator Cntinuus Quality Imprvement: Treatment Recrd Reviews Third Thursday Prvider Call (August 20, 2015) Wendy Bwlin, QM Administratr Gals f the Presentatin Review the findings f Treatment Recrd Review results

More information

High Performance Network Quality Criteria for Designation

High Performance Network Quality Criteria for Designation Selected quality measures include: Specialty Measure Descriptin Allergy / Immunlgy Asthma Drug Mgt Vaccine Pneumnia Vaccine High Perfrmance Netwrk Quality Criteria fr Designatin AvMed has selected certain

More information

Coronary Artery Disease (CAD): Beta Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (NQF 0070)

Coronary Artery Disease (CAD): Beta Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (NQF 0070) Crnary Artery Disease (CAD): Beta Blcker Therapy fr CAD Patients with Prir Mycardial Infarctin (MI) (NQF 0070) EMeasure Name Crnary Artery Disease EMeasure Id Pending (CAD): Beta Blcker Therapy fr CAD

More information

Cardiac Rehabilitation Services

Cardiac Rehabilitation Services Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin

More information

Solid Organ Transplant Benefits to Change for Texas Medicaid

Solid Organ Transplant Benefits to Change for Texas Medicaid Slid Organ Transplant Benefits t Change fr Texas Medicaid Infrmatin psted February 13, 2015 Nte: All new and updated prcedure cdes and their assciated reimbursement rates are prpsed benefits pending a

More information

2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizations, Clinical Cascade Breakout Session TB/HIV EXERCISE

2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizations, Clinical Cascade Breakout Session TB/HIV EXERCISE 2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizatins, Clinical Cascade Breakut Sessin TB/HIV EXERCISE Created by the ICPI TB/HIV Wrkstream Abut this Handut

More information

Quality ID #1 (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) National Quality Strategy Domain: Effective Clinical Care

Quality ID #1 (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) National Quality Strategy Domain: Effective Clinical Care Quality ID #1 (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:

More information

CONTACT: Amber Hamilton TYPE 2 DIABETES AND OBESITY: TWIN EPIDEMICS OVERVIEW

CONTACT: Amber Hamilton TYPE 2 DIABETES AND OBESITY: TWIN EPIDEMICS OVERVIEW FACT SHEET CONTACT: Amber Hamiltn 212-266-0062 TYPE 2 DIABETES AND OBESITY: TWIN EPIDEMICS OVERVIEW Type 2 diabetes accunts fr 90-95% f the 29.1 millin diabetes cases in the U.S. 1 Obesity is a majr independent

More information

Annual Assembly Abstract Review Process

Annual Assembly Abstract Review Process Annual Assembly Abstract Review Prcess AAHPM and HPNA cllabrate t review and select abstracts fr Annual Assembly. The cmmittees meet prir t the calls t review and update the Assembly bjectives (Planning

More information

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria Benefits fr Anesthesia Services fr the CSHCN Services Prgram t Change Effective fr dates f service n r after July 1, 2008, benefit criteria fr anesthesia will change fr the Children with Special Health

More information

NIA Magellan 1 Spine Care Program Interventional Pain Management Frequently Asked Questions (FAQs) For Medicare Advantage HMO and PPO

NIA Magellan 1 Spine Care Program Interventional Pain Management Frequently Asked Questions (FAQs) For Medicare Advantage HMO and PPO NIA Magellan 1 Spine Care Prgram Interventinal Pain Management Frequently Asked Questins (FAQs) Fr Medicare Advantage HMO and PPO Questin GENERAL Why is Flrida Blue implementing a Spine Management prgram

More information

Meaningful Use Roadmap Stage Edition Eligible Hospitals

Meaningful Use Roadmap Stage Edition Eligible Hospitals Meaningful Use Radmap Stage 1-2011 Editin Eligible Hspitals CPSI is dedicated t making yur transitin t Meaningful Use as seamless as pssible. Therefre, we have cme up with a radmap t assist yu in implementing

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-7 (NQF 0041): Preventive Care and Screening: Influenza Immunization Measure Steward: PCPI CMS Web Interface V2.1 Page 1 of 19 06/25/ Contents INTRODUCTION... 3 CMS WEB INTERFACE

More information

Quality ID #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care

Quality ID #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care Quality ID #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS F INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process DESCRIPTION: Percentage

More information

Childhood Immunization Status (NQF 0038)

Childhood Immunization Status (NQF 0038) Childhd Immunizatin Status (NQF 0038) EMeasure Name Childhd Immunizatin EMeasure Id Pending Status Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December

More information

(Please text me on once you have submitted your request online and the cell number you used)

(Please text me on once you have submitted your request online and the cell number you used) Dear Thank yu fr yur email, nted. Belw steps n hw t register as a service prvider. Please nte that nce yu have requested t becme a service prvider, yu need t sms/what s up me n 0826392585, in rder t activate

More information

Related Policies None

Related Policies None Medical Plicy MP 3.01.501 Guidelines fr Cverage f Mental and Behaviral Health Services Last Review: 8/30/2017 Effective Date: 8/30/2017 Sectin: Mental Health End Date: 08/19/2018 Related Plicies Nne DISCLAIMER

More information

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018) Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages

More information

Indications and Limitations of Coverage and/or Medical back to top

Indications and Limitations of Coverage and/or Medical back to top Fr services perfrmed n r after 09/15/2009 Original Determinatin Ending Date Revisin Effective Date Revisin Ending Date Indicatins and Limitatins f Cverage and/r Medical Necessity Indicatins Medicare cverage

More information

Diabetes Mellitus Lab Tests (Screening, Diagnosis & Monitoring)

Diabetes Mellitus Lab Tests (Screening, Diagnosis & Monitoring) Rule Categry: Medical ` Ref: N: 2013-MN-0012 Versin Cntrl: Versin N. 1.1 Effective Date: December 2013 Revisin Date: December 2014 Diabetes Mellitus Lab Tests (Screening, Diagnsis & Mnitring) Adjudicatin

More information

Rate Lock Policy. Contents

Rate Lock Policy. Contents Rate Lck Plicy Cntents Rate Lcks... 2 Rate Lck Cnfirmatin... 2 Lck Term... 2 Pre-Lck... 2 Maximum Qualified Rate... 3 Extensins... 3 Cst t Extend... 3 Relcks... 4 Re-Negtiatin r Flat Dwn Plicy... 4 Prgram

More information

Assessment criteria for Primary Health Disciplines Eligibility for Recognition as Credentialled Diabetes Educator. December 2015 ADEA

Assessment criteria for Primary Health Disciplines Eligibility for Recognition as Credentialled Diabetes Educator. December 2015 ADEA Assessment criteria fr Primary Health Disciplines Eligibility fr Recgnitin as Credentialled Diabetes Educatr December 2015 ADEA ASSESSMENT CRITERIA FOR PRIMARY HEALTH DICIPLINES ELIGIBILITY FOR RECOGNITION

More information

2013 DATA COLLECTION GUIDE Summary Data Submission. Optimal Asthma Care. (07/01/2012 to 06/30/2013 Dates of Service)

2013 DATA COLLECTION GUIDE Summary Data Submission. Optimal Asthma Care. (07/01/2012 to 06/30/2013 Dates of Service) 2013 DATA COLLECTION GUIDE Summary Data Submissin Optimal Asthma Care (07/01/2012 t 06/30/2013 Dates f Service) Htline: 612-746-4522 E-mail: supprt@mncm.rg Data Prtal: https://data.mncm.rg/lgin MN Cmmunity

More information

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For PA Health & Wellness Providers

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For PA Health & Wellness Providers Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQ s) Fr PA Health & Wellness Prviders Questin GENERAL Why is PA Health & Wellness implementing a Medical Specialty Slutins Prgram? Answer

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface CARE-2 (NQF 0101): Falls: Screening for Future Fall Risk Measure Steward: NCQA CMS Web Interface V2.1 Page 1 of 18 12/11/2017 Contents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION...

More information

Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or

Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or Heart Failure (HF): Angitensin Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) (NQF 0081) EMeasure Name Heart Failure (HF): Angitensin

More information

Commissioning Policy: South Warwickshire CCG (SWCCG)

Commissioning Policy: South Warwickshire CCG (SWCCG) Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding

More information

Measure #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care

Measure #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care Measure #117 (NQF 0055): Diabetes: Eye Exam National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS F INDIVIDUAL MEASURES: CLAIMS ONLY MEASURE TYPE: Process DESCRIPTION: Percentage of patients

More information

Independent Charitable Patient Assistance Program (IPAP) Code of Ethics

Independent Charitable Patient Assistance Program (IPAP) Code of Ethics Independent Charitable Patient Assistance Prgram (IPAP) Cde f Ethics Independent charitable patient assistance prgrams (IPAPs) fcus n the needs f patients wh are insured, meet certain financial limitatin

More information

LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST

LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST OPTUM LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY / APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED

More information

Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or

Heart Failure (HF): Angiotensin Converting Enzyme (ACE) Inhibitor or Heart Failure (HF): Angitensin Cnverting Enzyme (ACE) Inhibitr r Angitensin Receptr Blcker (ARB) Therapy fr Left Ventricular Systlic Dysfunctin (LVSD) (NQF 0081) EMeasure Name Heart Failure (HF): EMeasure

More information

2018 CMS Web Interface

2018 CMS Web Interface CMS Web Interface PREV-7 (NQF 0041): Preventive Care and Screening: Influenza Immunization Measure Steward: PCPI CMS Web Interface V2.0 Page 1 of 19 11/13/2017 Contents INTRODUCTION... 3 CMS WEB INTERFACE

More information

Pediatric and adolescent preventive care and HEDIS *

Pediatric and adolescent preventive care and HEDIS * Pediatric and adlescent preventive care and HEDIS * * HEDIS is a registered trademark f the Natinal Cmmittee fr Quality Assurance (NCQA). UniCare Health Plan f West Virginia, Inc. Healthcare Effectiveness

More information

Record of Revisions to Patient Tracking Spreadsheet Template

Record of Revisions to Patient Tracking Spreadsheet Template Recrd f Revisins t Patient Tracking Spreadsheet Template Belw is a recrd f revisins made by the AIMS Center t the Patient Tracking Spreadsheet Template. The purpse f this dcument is t infrm spreadsheet

More information

Ancillary Symposia Request for Proposals Partner with the Endocrine Society to Educatte the Endocrine Community.

Ancillary Symposia Request for Proposals Partner with the Endocrine Society to Educatte the Endocrine Community. Ancillary Sympsia Request fr Prpsals Partnerr with the Endcrine Sciety t Educate the Endcrine Cmmunity. Jin the Endcrine Sciety in Bstn fr the 98 th Annual Meeting & Exp frm April 1 4, 2016. ENDO 2016

More information

Wound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018

Wound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018 Wund Care Equipment and Supply Benefits t Change fr Texas Medicaid July 1, 2018 Infrmatin psted May 11, 2018 Nte: Texas Medicaid managed care rganizatins (MCOs) must prvide all medically necessary, Medicaid-cvered

More information

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH Aurra Health Care s Research Subject Prtectin Prgram (RSPP) This guidance dcument will utline the prper prcedures fr btaining and dcumenting

More information

Service Change Process. Gateway 1 High-level Proposition. Innovation project name: Patient Self-Monitoring/Management of Warfarin

Service Change Process. Gateway 1 High-level Proposition. Innovation project name: Patient Self-Monitoring/Management of Warfarin Service Change Prcess Gateway 1 High-level Prpsitin Innvatin prject name: Patient Self-Mnitring/Management f Warfarin NHS Bury Please describe the service change being prpsed. Please describe what service(s)

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

Statement of Work for Linked Data Consulting Services

Statement of Work for Linked Data Consulting Services A. Backgrund Infrmatin Statement f Wrk fr Linked Data Cnsulting Services The Natinal Library f Medicine (NLM), in Bethesda, Maryland, is a part f the Natinal Institutes f Health, US Department f Health

More information

Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP

Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP Cntinuus Psitive Airway Pressure (CPAP) and Respiratry Assist Devices (RADs), Including Bi-Level PAP Benefit Criteria t Change fr Texas Medicaid Effective March 1, 2017 Overview f Benefit Changes Benefit

More information

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Managed Health Services (MHS)

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Managed Health Services (MHS) Questin GENERAL Why did MHS implement a Medical Specialty Slutins Prgram? Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Managed Health Services (MHS) Answer Effective Nvember

More information

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS INTRODUCTION This ntice prvides an verview f the parental special educatin rights, smetimes called prcedural safeguards

More information

Hospital Preparedness Checklist

Hospital Preparedness Checklist Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been

More information

Appendix C. Master of Public Health. Practicum Guidelines

Appendix C. Master of Public Health. Practicum Guidelines Appendix C Master f Public Health Practicum Guidelines 0 Gergia State University, Schl f Public Health Master f Public Health Practicum Guidelines Fr mre infrmatin, cntact Jessica Hwell Pratt, MPH Practicum

More information

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Louisiana Healthcare Connections Providers

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Louisiana Healthcare Connections Providers Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Luisiana Healthcare Cnnectins Prviders Questin GENERAL Why did Luisiana Healthcare Cnnectins implement a Medical Prgram? Answer

More information

o Procedures performed o Diagnoses Identified o Certain devices/equipment/supplies acquired for patient

o Procedures performed o Diagnoses Identified o Certain devices/equipment/supplies acquired for patient Image Surce: https://s-media-cache-ak0.pinimg.cm/736x/7c/29/91/7c2991805f004e1ca05e42a79883f4a7.jpg 6/30/2017 Curse Objectives A Practical Guide t Cding fr Audilgists in 2017 Megan Keirans, AuD University

More information

Annual Principal Investigator Worksheet About Local Context

Annual Principal Investigator Worksheet About Local Context Cmpleting the NCI CIRB Annual Principal Investigatr Wrksheet Abut Lcal Cntext and the Study-Specific Wrksheet Abut Lcal Cntext at the University f Iwa All investigatrs cnducting research with the Natinal

More information

Novel methods and approaches for sensing, evaluating, modulating and regulating mood and emotional states.

Novel methods and approaches for sensing, evaluating, modulating and regulating mood and emotional states. Nvel methds and appraches fr sensing, evaluating, mdulating and regulating md and emtinal states. 2018 Jy Academic Grant Call fr Prpsals Intrductin The Annual Jy grant initiative aims t prmte and cntribute

More information

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic

More information

Fee Schedule - Home Health Care- 2015

Fee Schedule - Home Health Care- 2015 Fee Schedule - Hme Health Care- 2015 01/01/2015 1600 E Century Ave Ste 1 PO Bx 5585 Bismarck ND 58506-5585 www.wrkfrcesafety.cm Cpyright Ntice The five character cdes included in the Nrth Dakta Fee Schedule

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

CDC Influenza Division Key Points MMWR Updates February 20, 2014

CDC Influenza Division Key Points MMWR Updates February 20, 2014 CDC Influenza Divisin Key Pints MMWR Updates In this dcument: Summary Key Messages Seasnal Influenza Vaccine Effectiveness: Interim Adjusted Estimates Influenza Surveillance Update: September 29, 2013-February

More information

Medical Student Immunization Requirements

Medical Student Immunization Requirements Medical Student Immunizatin Requirements The State f Illinis cde, Reference: (110 ILCS 20) Cllege Student Immunizatin Act, requires students t prvide prf f immunity: Measles (Rubela), Mumps, Rubella (German

More information

Michigan Primary Care Transformation Project Performance Incentive Technical Manual

Michigan Primary Care Transformation Project Performance Incentive Technical Manual Michigan Primary Care Transfrmatin Prject 2016 Perfrmance Incentive Technical Manual Fr Physician Organizatins, Physician Hspital Organizatins, Independent Practice Assciatins and Primary Care Practices

More information

World Confederation for Physical Therapy Congress , May Singapore

World Confederation for Physical Therapy Congress , May Singapore Wrld Cnfederatin fr Physical Therapy Cngress 2015 1-4, May Singapre Call fr applicatins fr Chair f the Internatinal Scientific Cmmittee The Executive Cmmittee f WCPT invites applicatins and suggestins

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Plicy Name: Plicy Number: Respnsible Department(s): CLINICAL MEDICAL POLICY Supervised Exercise Therapy fr Peripheral Artery Disease (PAD) MP-077-MD-DE Medical Management Prvider Ntice Date: 01/15/2019

More information

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps.

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps. NAU Mdel Observatin Prtcl The mdel prtcl was develped with supprt and expertise frm the Natinal Institute fr Excellence in Teaching (NIET) and is based in great part n NIET s extensive experience cnducting

More information

Commonwealth of Kentucky Department for Medicaid Services Division of Program Quality and Outcomes

Commonwealth of Kentucky Department for Medicaid Services Division of Program Quality and Outcomes Cmmnwealth f Kentucky Department fr Medicaid Services Divisin f Prgram Quality and Outcmes EPSDT Screening Encunter Data Validatin Clinical Fcused Study 2014 FINAL REPORT May 2014 TABLE OF CONTENTS INTRODUCTION...

More information

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the

More information

UNM SRMC SLEEP MEDICINE CLINICAL PRIVILEGES.

UNM SRMC SLEEP MEDICINE CLINICAL PRIVILEGES. Initial privileges (initial appintment) Renewal f privileges (reappintment) Expansin f privileges (mdificatin) INSTRUCTIONS All new applicants must meet the fllwing requirements as apprved by the UNM SRMC

More information

The clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only.

The clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only. The clinical trial infrmatin prvided in this public disclsure synpsis is supplied fr infrmatinal purpses nly. Please nte that the results reprted in any single trial may nt reflect the verall ptential

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synpsis fr Public Disclsure This clinical study synpsis is prvided in line with Behringer Ingelheim s Plicy n Transparency and Publicatin f Clinical Study Data. The synpsis which is

More information

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin Revisin 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin TABLE OF CONTENTS TABLE OF CONTENTS...

More information

2016 CWA Political Action Fund Administrative Procedures Checklist

2016 CWA Political Action Fund Administrative Procedures Checklist 2016 CWA Plitical Actin Fund Administrative Prcedures Checklist 1. Dates f Prgram The 2016 CWA Plitical Actin Fund (federal plitical actin cmmittee- CWA-COPE PCC) Prgram will be cnducted n a calendar year

More information

Structured Assessment using Multiple Patient. Scenarios (StAMPS) Exam Information

Structured Assessment using Multiple Patient. Scenarios (StAMPS) Exam Information Structured Assessment using Multiple Patient Scenaris (StAMPS) Exam Infrmatin 1. Preparing fr the StAMPS assessment prcess StAMPS is an assessment mdality that is designed t test higher rder functins in

More information

Physical Fitness for the Physically Limited. o Work Experience, General. o Open Entry/Exit. Distance (Hybrid Online) for online supported courses

Physical Fitness for the Physically Limited. o Work Experience, General. o Open Entry/Exit. Distance (Hybrid Online) for online supported courses SECTION A - Curse Infrmatin 1. Curse ID: 2. Curse Title: 3. Divisin: 4. Department: 5. Subject: 6. Shrt Curse Title: 7. Effective Term:: KINL 2 Physical Fitness fr the Physically Limited Kinesilgy & Athletics

More information