NOA 3rd Party Newsletter PQRS EDITION - Page 1 CONTENTS. Traffic Sheet P.3. Flowsheet & Detailed Directions P.11.

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1 NOA 3rd Party Newsletter PQRS EDITION - Page 1 CONTENTS EYE MEASURES Measure #12 :Primary Open-Angle Glaucoma: Optic Nerve Evaluation Traffic Sheet P.2. Flowsheet & Detailed Directions P.8. Measure #141: Primary Open-Angle Glaucoma: Reduction of IOP by 15% Documentation of a Plan of Care Traffic Sheet P.2. Flowsheet & Detailed Directions P.9. Measure #14: Macular Degeneration: Dilated Macular Examination Traffic Sheet P.3. Flowsheet & Detailed Directions P.10. Measure #140: Macular Degeneration: Counseling on Antioxidant Supplement Traffic Sheet P.3. Flowsheet & Detailed Directions P.11. Measure #19: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Traffic Sheet P.4. Flowsheet & Detailed Directions P.12. Measure #117: Diabetes: Eye Exam Traffic Sheet P.4. Flowsheet & Detailed Directions P.13. CROSS-CUTTING MEASURES Measure #130: Documentation of Current Medications Traffic Sheet P.5. Flowsheet & Detailed Directions P.14. Measure #131: Pain Assessment & Follow-up. Traffic Sheet P.6. Flowsheet & Detailed Directions P.15. Measure #226: Tobacco Use: Screening and Cessation Intervention Traffic Sheet P.5. Flowsheet & Detailed Directions P.16. Measure #317: Screening for HBP and Follow-up Documented Traffic Sheet P.7. Flowsheet & Detailed Directions P.17. 3RD PARTY NEWS Nebraska Optometric Association January MEDICARE CLAIMS BASED PQRS REPTING Penalty: 2016 PQRS participation avoids a 4% cut in all 2018 Medicare payments (2% PQRS penalty and 2% VBM penalty) PQRS Measures: A total of ten 2016 PQRS measures are applicable to optometry. Nine of these must be reported on appropriate patients at least 50 percent of the time for the full year (1/1/ /31/2016). The appropriate measures include six eye-specific measures and three of four available crosscutting [general health] measures. Click any measure below for a complete and detailed CMS explanation of PQRS coding. Eye-specific Measures: Report on all six of these on diagnosis-appropriate patients. Measure #12 :Primary Open-Angle Glaucoma: Optic Nerve Evaluation Measure #141: Primary Open-Angle Glaucoma: Reduction of IOP by 15% Documentation of a Plan of Care Measure #14: Macular Degeneration: Dilated Macular Examination Measure #140: Macular Degeneration: Counseling on Antioxidant Supplement Measure #19: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Measure #117: Diabetes: Eye Exam Cross-cutting Measures: Chose three of the following four, and use those three consistently. These measures must be filed on every patient 18-years-old and older. Measure #130: Current Medications Documented Measure #131: Pain Assessment and Follow-up Measure #226: Tobacco Use: Screening and Cessation Intervention documented Measure #317: High Blood Pressure Screening and Follow-up documented IMPTANT REPTING RESOURCES Dr. Quack s PQRS in-office traffic sheets are found on the following six pages. They are derived from CMS individual measure specifications for claims based and registry reporting. CMS flow sheets and step-by-step instructions follow on the subsequent 10 pages. Dr. Quack did his best to transfer the CMS specifications from the CMS website to the in-office traffic sheets. However, prior to using the Quack traffic sheets, we recommend reviewing CMS s comprehensive PQRS instructions. They are available by clicking on each underlined title in the measures list to the left of this box. This 17 page 2016 PQRS Newsletter is arranged as follows: Pages 2-7 are traffic sheets prepared by Dr. Quack to use in your office when filing claims-based PQRS measures. These six pages can be printed back-to-back as follows: GLC back-to-back with AMD [labeled as pages 1a & 1b in the upper right corner] Diabetes back-to-back with Pain Assessment [labeled 2a & 2b in upper right corner] Med List & Tobacco back-to-back with Blood Pressure [labeled 3a & 3b in upper right corner] Pages 8-17 contain screenshots of CMS flowsheets and step-by-step directions how to file the claims-based PQRS measures listed above. (Complete CMS directions can be found by clicking on the underlined names of each measure above this box.)

2 GLC NOA 3rd Party Newsletter PQRS EDITION - Page 2 IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below Directions: For each patient visit which includes both a service and diagnosis listed below, circle the appropriate ICD diagnosis codes and CPT service codes, then check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for both measures (#12 and #141). [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] Measure #12 (NQF 0086): Primary Open-Angle Glaucoma: Optic Nerve Evaluation DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months DENOMINAT: All patients aged 18 years and older with a diagnosis of POAG Patients aged 18 years on date of encounter Diagnosis for primary open-angle glaucoma: H40.10X0, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.11X0, H40.11X1, H40.11X2, H40.11X3, H40.11X4, H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H40.151, H40.152, H40.153, H Patient encounter during the reporting period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, NUMERAT: Patients who have an optic nerve head evaluation during one or more office visits within 12 months Numerator Quality-Data Coding Options for Reporting Satisfactorily: Optic Nerve Head Evaluation Performed Performance Met: CPT II 2027F Optic nerve head evaluation performed Optic Nerve Head Evaluation not Performed for Medical Reasons Append a modifier (1P) to CPT Category II code 2027F to report documented circumstances that appropriately exclude patients from the denominator. Medical Performance Exclusion: 2027F with 1P: Documentation of medical reason(s) for not performing an optic nerve head evaluation Optic Nerve Head Evaluation not Performed, Reason not Otherwise Specified Append a reporting modifier (8P) to CPT Category II code 2027F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. Performance NOT met: 2027F with 8P: Optic nerve head evaluation was not performed, reason not otherwise specified Measure #141 (NQF 0563): Primary Open-Angle Glaucoma: Reduction of IOP by 15% Documentation of a Plan of Care Page 1a DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) if the most recent IOP was not reduced by at least 15% from the preintervention level, a plan of care was documented within 12 months DENOMINAT: All patients aged 18 years and older with a diagnosis of POAG Patients aged 18 years on date of encounter Diagnosis for primary open-angle glaucoma: H40.10X0, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.11X0, H40.11X1, H40.11X2, H40.11X3, H40.11X4, H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H , H40.151, H40.152, H40.153, H Patient encounter during the reporting period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, NUMERAT: Patients whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months Definitions: Plan of Care May include: recheck of IOP at specified time, change in therapy, perform additional diagnostic evaluations, monitoring per patient decisions or health system reasons, and/or referral to a specialist. Plan to Recheck In the event certain factors do not allow for the IOP to be measured (e.g., patient has an eye infection) but the physician has a plan to measure the IOP at the next visit; the plan of care code should be reported. Glaucoma Treatment Not Failed The most recent IOP was reduced by at least 15% in the affected eye or if both eyes were affected, the reduction of at least 15% occurred in both eyes. NUMERAT NOTE: The correct combination of numerator code(s) must be reported on the claim form in order to properly report this measure. The correct combination of codes may require the submission of multiple numerator codes. Numerator Options: Performance Met: CPT II 3284F Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level Performance Met: CPT II 0517F Glaucoma plan of care documented CPT II 3285F Intraocular pressure (IOP) reduced by a value less than 15% from the preintervention level Performance Not Met: CPT II 0517F with 8P Glaucoma plan of care not documented, reason not otherwise specified CPT II 3285F Intraocular pressure (IOP) reduced by a value less than 15% from the preintervention level Performance Not Met: CPT II 3284F with 8P IOP measurement not documented, reason not otherwise specified

3 NOA 3rd Party Newsletter PQRS EDITION - Page 3 AMD IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below Directions: For each patient visit which includes both a service and diagnosis listed below, circle the appropriate ICD diagnosis codes and CPT service codes, then check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for both measures (#14 and #140). [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] Measure #14 (NQF 0087): Age-Related Macular Degeneration (AMD): Dilated Macular Exam DESCRIPTION: Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage the level of macular degeneration severity during one or more office visits within 12 months DENOMINAT: All patients aged 50 years and older with a diagnosis of AMD Patients aged 50 years on date of encounter Diagnosis for age-related macular degeneration: H35.30, H35.31, H35.32 Patient encounter during the reporting period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, Page 1b Measure #140 (NQF 0566): Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement DESCRIPTION: Percentage of patients aged 50 years and older with a diagnosis of agerelated macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for preventing progression of AMD DENOMINAT: All patients aged 50 years and older with a diagnosis of AMD Patients aged 50 years on date of encounter Diagnosis for AMD: H35.30, H35.31, H35.32 Patient encounter during the reporting period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, NUMERAT: Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage the level of macular degeneration severity during one or more office visits within 12 months Definitions: Macular Thickening Acceptable synonyms for macular thickening include: intraretinal thickening, serous detachment of the retina, pigment epithelial detachment. Severity of Macular Degeneration Mild, moderate, or severe. Numerator Quality-Data Coding Options for Reporting Satisfactorily: Dilated Macular Examination Performed Performance Met: CPT II 2019F: Dilated macular exam performed, including documentation of the presence or absence of macular thickening or hemorrhage the level of macular degeneration severity Dilated Macular Examination not Performed for Medical or Patient Reasons Append a modifier (1P or 2P) to CPT Category II code 2019F to report documented circumstances that appropriately exclude patients from the denominator. Medical Performance Exclusion: 2019F with 1P: Documentation of medical reason(s) for not performing a dilated macular examination Patient Performance Exclusion; 2019F with 2P: Documentation of patient reason(s) for not performing a dilated macular examination Dilated Macular Examination not Performed, Reason not Otherwise Specified Append a reporting modifier (8P) to CPT Category II code 2019F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. Performance NOT met; 2019F with 8P: Dilated macular exam was not performed, reason not otherwise specified NUMERAT: Patients with AMD or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the AREDS formulation for preventing progression of AMD Definition: Counseling Documentation in the medical record should include a discussion of risk or benefits of the AREDS formulation. Counseling can be discussed with all patients with AMD, even those who do not meet the criteria for the AREDS formulation as outlined in the AREDS. The ophthalmologist or optometrist can explain why these supplements are not appropriate for their particular situation. Also, given the purported risks associated with antioxidant use, patients would be informed of the risks and benefits and make their choice based on valuation of vision loss vs. other risks. As such, the measure seeks to educate patients about overuse as well as appropriate use. NUMERAT NOTE: If patient is already receiving AREDS formulation, the assumption is that counseling about AREDS has already been performed. Numerator Quality-Data Coding Options for Reporting Satisfactorily: AREDS Counseling Performed Performance Met: CPT II 4177F: Counseling about the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for preventing progression of age-related macular degeneration (AMD) provided to patient and/or caregiver(s) AREDS Counseling not Performed, Reason not Otherwise Specified Append a reporting modifier (8P) to CPT Category II code 4177F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. Performance NOT met: 4177F with 8P: AREDS counseling not performed, reason not otherwise specified

4 Diab NOA 3rd Party Newsletter PQRS EDITION - Page 4 IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below Directions: For each patient visit which includes both a service and diagnosis listed below, circle the appropriate ICD diagnosis codes and CPT service codes, then check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for both measures (#19 and #117). [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] Page 2a Measure #19 (NQF 0089): Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months DENOMINAT: All patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed Patients aged 18 years on date of encounter Diagnosis for diabetic retinopathy: E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E Patient encounter during the reporting period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, NUMERAT: Patients with documentation, at least once within 12 months, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient s diabetic care Definitions: Communication May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient s diabetic care a copy of a letter in the medical record to the clinician managing the patient s diabetic care outlining the findings of the dilated macular or fundus exam. Findings Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) the presence or absence of macular edema. NUMERAT NOTE: The correct combination of numerator code(s) must be reported on the claim form in order to properly report this measure. The correct combination of codes may require the submission of multiple numerator codes. Numerator Quality-Data Coding Options for Reporting Satisfactorily: Dilated Macular or Fundus Exam Findings Communicated Performance Met: (One CPT II code & one quality-data code [5010F & G8397] are required on the claim form to submit this numerator option) CPT II 5010F: Findings of dilated macular or fundus exam communicated to the physician managing the diabetes care G8397: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema level of severity of retinopathy Dilated Macular or Fundus Exam Findings not Communicated for Medical Reasons or Patient Reasons Medical Performance Exclusion or Patient Perfomance Exclusion: (One CPT II code & one qualitydata code [5010F-xP & G8397] are required on the claim form to submit this numerator option) Append a modifier (1P or 2P) to CPT Category II code 5010F to report documented circumstances that appropriately exclude patients from the denominator. 5010F with 1P: Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes 5010F with 2P: Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes G8397: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema level of severity of retinopathy If patient is not eligible for this measure because patient did not have dilated macular or fundus exam performed, report: (One quality-data code [G8398] is required on the claim form to submit this numerator option) Performance Exclusion: G8398: Dilated macular or fundus exam not performed Dilated Macular or Fundus Exam Findings not Communicated, Reason not Otherwise Specified (One CPT II code & one quality-data code [5010F-8P & G8397] are required on the claim form to submit this numerator option) Append a reporting modifier (8P) to CPT Category II code 5010F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. Performance NOT met: 5010F with 8P: Findings of dilated macular or fundus exam was not communicated to the physician managing the diabetes care, reason not otherwise specified G8397: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema level of severity of retinopathy Measure #117 (NQF 0055): Diabetes: Eye Exam DESCRIPTION: Percentage of patients years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period DENOMINAT: All patients aged 18 through 75 years of age who had a diagnosis of diabetes with a visit during the measurement period Patients 18 through 75 years of age on date of encounter Diagnosis for diabetes: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13, O24.311, O24.312, O24.313, O24.319, O24.32, O24.33, O24.811, O24.812, O24.813, O24.819, O24.82, O24.83 Patient encounter during the reporting period (CPT or HCPCS): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439 NUMERAT: Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal or dilated exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period NUMERAT NOTE: The eye exam must be performed or reviewed by an ophthalmologist or optometrist. Alternatively, results may be read by a qualified reading center that operates under the direction of a medical director who is a retinal specialist. Numerator Quality-Data Coding Options for Reporting Satisfactorily: Retinal or Dilated Eye Exam Performed by an Eye Care Professional Performance Met: CPT II 2022F: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed Performance Met: CPT II 2024F: Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed Performance Met: CPT II 2026F: Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed Performance Met: CPT II 3072F: Low risk for retinopathy (no evidence of retinopathy in the prior year)* *Note: This code can only be used if the claim/encounter was during the measurement period because it indicates that the patient had no evidence of retinopathy in the prior year. This code definition indicates results were negative; therefore an automated result is not required. Retinal or Dilated Eye Exam not Performed, Reason not Otherwise Specified Append a reporting modifier (8P) to CPT Category II code 2022F or 2024F or 2026F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified. Performance NOT Met: CPT II 2022F or 2024F or 2026F with 8P: Dilated eye exam was not performed, reason not otherwise specified

5 NOA 3rd Party Newsletter PQRS EDITION - Page 5 **ALL** Med List and Tobacco (file on all patients =>18) IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below NOTE: TO AVOID THE 2018 PENALTY, THREE CONSISTENT CROSS-CUTTING MEASURES MUST BE REPTED ON EVERY PATIENT 18 & OLDER Directions: For each patient 18 years old and older, check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for THREE CONSISTENT CROSS-CUTTING measures (Chose three from #130, #131, #226 and #317) avoid the 2018 penalty. [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] Page 3a (front side) Measure #130 (NQF 0419): Documentation of Current Medications in the Medical Record DESCRIPTION: Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements must contain the medications name, dosage, frequency and route of administration. DENOMINAT: All visits for patients aged 18 years and older Patients aged 18 years on date of encounter Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90957, 90958, 90959, 90960, 90962, 90965, 90966, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, 92626, 96116, 96150, 96152, 97001, 97002, 97003, 97004, 97110, 97140, 97532, 97802, 97803, 97804, 98960, 98961, 98962, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0101, G0108, G0270, G0402, G0438, G0439 NUMERAT: Eligible professional attests to documenting, updating or reviewing a patient s current medications using all immediate resources available on the date of encounter. This list must include ALL prescriptions, over-the counters, herbals, and vitamin/ mineral/dietary (nutritional) supplements must contain the medications name, dosages, frequency and route of administration Definitions: Current Medications - Medications the patient is presently taking including all prescriptions, over-the-counters, herbals and vitamin/mineral/dietary (nutritional) supplements with each medication s name, dosage, frequency and administered route. Route - Documentation of the way the medication enters the body (some examples include but are not limited to: oral, sublingual, subcutaneous injections, and/or topical) Not Eligible - A patient is not eligible if the following reason is documented: Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient s health status NUMERAT NOTE: The eligible professional must document in the medical record they obtained, updated, or reviewed a medication list on the date of the encounter. Eligible professionals reporting this measure may document medication information received from the patient, authorized representative(s), caregiver(s) or other available healthcare resources. G8427 should be reported if the eligible professional documented that the patient is not currently taking any medications. Numerator Quality-Data Coding Options for Reporting Satisfactorily: Current Medications Documented Performance Met: G8427: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient s current medications Current Medications not Documented, Patient not Eligible Performance Exclusion: G8430: Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional Current Medications with Name, Dosage, Frequency, or Route not Documented, Reason not Given Performance NOT Met: G8428: Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given Measure #226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention DESCRIPTION: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months who received cessation counseling intervention if identified as a tobacco user DENOMINAT: All patients aged 18 years and older Patients aged 18 years on date of encounter Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96150, 96151, 96152, 97003, 97004, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, 99407, G0438, G0439 NUMERAT: Patients who were screened for tobacco use at least once within 24 months who received tobacco cessation intervention if identified as a tobacco user Definitions: Tobacco Use Includes use of any type of tobacco. Tobacco Cessation Intervention Includes brief counseling (3 minutes or less), and/or pharmacotherapy. NUMERAT NOTE: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation intervention report 4004F with 8P. Numerator Quality-Data Coding Options for Reporting Satisfactorily: Patient Screened for Tobacco Use, Identified as a User and Received Intervention Performance Met: CPT II 4004F: Patient screened for tobacco use received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco Performance Met: CPT II 1036F: Current tobacco non-user Medical Performance Exclusion:Tobacco Screening not Performed for Medical Reasons 4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reasons) Performance NOT Met: Tobacco Screening Tobacco Cessation Intervention not Performed Reason Not Otherwise Specified 4004F with 8P: Tobacco screening tobacco cessation intervention not performed, reason not otherwise specified

6 NOA 3rd Party Newsletter PQRS EDITION - Page 6 **ALL** Pain Assessment (file on all patients =>18) IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below NOTE: TO AVOID THE 2018 PENALTY, THREE CONSISTENT CROSS-CUTTING MEASURES MUST BE REPTED ON EVERY PATIENT 18 & OLDER Directions: For each patient 18 years old and older, check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for THREE CONSISTENT CROSS-CUTTING measures (Chose three from #130, #131, #226 and #317) avoid the 2018 penalty. [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] Page 2b (back side ) Measure #131 (NQF 0420): Pain Assessment & Follow-Up DESCRIPTION: Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit documentation of a follow-up plan when pain is present DENOMINAT: All visits for patients aged 18 years and older Patients aged 18 years on date of encounter Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97001, 97002, 97003, 97004, 97532, 98940, 98941, 98942, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0402, G0438, G0439 NUMERAT: Patient visits with a documented pain assessment using a standardized tool(s) documentation of a follow-up plan when pain is present Definitions: Pain Assessment Documentation of a clinical assessment for the presence or absence of pain using a standardized tool is required. A multi-dimensional clinical assessment of pain using a standardized tool may include characteristics of pain, such as: location, intensity, description, and onset/duration. Standardized Tool An assessment tool that has been appropriately normalized and validated for the population in which it is used. Examples of tools for pain assessment, include, but are not limited to: Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS) and Visual Analog Scale (VAS). Follow-Up Plan A documented outline of care for a positive pain assessment is required. This must include a planned follow-up appointment or a referral, a notification to other care providers as applicable indicate the initial treatment plan is still in effect. These plans may include pharmacologic and/or educational interventions. Not Eligible A patient is not eligible if one or more of the following reason(s) is documented: Numerator Quality-Data Coding Options for Reporting Satisfactorily: Pain Assessment Documented as Positive Follow-Up Plan Documented (One quality-data code [G8730 or G8731] is required on the claim form to submit this numerator option) Performance Met: G8730: Pain assessment documented as positive using a standardized tool a follow-up plan is documented Pain Assessment Documented as Negative, No Follow-Up Plan Required Performance Met: G8731: Pain assessment using a standardized tool is documented as negative, no follow-up plan required Pain Assessment not Documented Patient not Eligible (One quality-data code [G8442 or G8939] is required on the claim form to submit this numerator option) Performance Exclusion: G8442: Pain assessment NOT documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool Pain Assessment Documented as Positive, Follow-Up Plan not Documented, Patient not Eligible Performance Exclusion: G8939: Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible Pain Assessment not Documented, Reason not Given (One quality-data code [G8732 or G8509] is required on the claim form to submit this numerator option) Performance Not Met: G8732: No documentation of pain assessment, reason not given Pain Assessment Documented as Positive, Follow-Up Plan not Documented, Reason not Given Performance Not Met: G8509: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others. For example, cases where pain cannot be accurately assessed through use of nationally recognized standardized pain assessment tools Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient s health status NUMERAT NOTE: The standardized tool used to assess the patient s pain must be documented in the medical record (exception: A provider may use a fraction such as 5/10 for Numeric Rating Scale without documenting this actual tool name when assessing pain for intensity)

7 **ALL** Screen BP & Followup (file on all patients =>18) NOA 3rd Party Newsletter PQRS EDITION - Page 7 IN OFFICE TRAFFIC SHEET For CMS Details, click on Measure # below Page NOTE: TO AVOID THE 2018 PENALTY, THREE CONSISTENT CROSS-CUTTING MEASURES MUST BE REPTED ON EVERY PATIENT 18 & OLDER Directions: For each patient 18 years old and older, check the box next to the appropriate CPT II codes (the numerator ), which your staff will then file on that same Medicare claim. File for THREE CONSISTENT CROSS-CUTTING measures (Chose three from #130, #131, #226 and #317) avoid the 2018 penalty. [Note: if Performance NOT met, your PQRS performance score will be adversely affected.] 3b (back side) Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented DESCRIPTION: Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated. DENOMINAT: All patients aged 18 years and older Patients aged 18 years Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90880, 92002, 92004, 92012, 92014, 96118, 97532, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, D7140, D7210, G0101, G0402, G0438, G0439 NUMERAT: Patients who were screened for high blood pressure have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive NUMERAT NOTE: Although the recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, BP screening and follow-up must be performed once per measurement period. For patients with Normal blood pressure a follow-up plan is not required. Definitions: Blood Pressure (BP) Classification: BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings. Recommended BP Follow-Up: The current Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the Recommended Blood Pressure Follow-Up Interventions listed below. Recommended Lifestyle Modifications: The current JNC report outlines lifestyle modifications which must include one or more of the following as indicated: Weight Reduction Dietary Approaches to Stop Hypertension (DASH) Eating Plan Dietary Sodium Restriction Increased Physical Activity Moderation in alcohol (ETOH) Consumption Second Hypertensive Reading: Requires a BP reading of Systolic BP 140 mmhg Diastolic BP 90 mmhg during the current encounter a most recent BP reading within the last 12 months Systolic BP 140 mmhg Diastolic BP 90 mmhg Second Hypertensive BP Reading Interventions: The current JNC report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated: Anti-Hypertensive Pharmacologic Therapy Laboratory Tests Electrocardiogram (ECG) Recommended Blood Pressure Follow-up Interventions: Normal BP: No follow-up required for Systolic BP <120 mmhg Diastolic BP < 80 mmhg Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of mmhg diastolic BP of mmhg recommended lifestyle modifications referral to Alternate/Primary Care Provider First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmhg diastolic BP >= 90 mmhg: Follow-up with rescreen 1 day and 4 weeks recommend lifestyle modifications referral to Alternative/Primary Care Provider Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >= 140 mmhg diastolic BP >= 90 mmhg: Follow-up with Recommended lifestyle modifications one or more of the Second Hypertensive Reading Interventions referral to Alternative/Primary Care Provider Recommended Blood Pressure Follow-Up Table Not Eligible A patient is not eligible if one or more of the following reason(s) are documented: Patient has an active diagnosis of hypertension Patient refuses to participate (either BP measurement or follow-up) Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient s health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated Numerator Quality-Data Coding Options for Reporting Satisfactorily: Normal Blood Pressure Reading Documented, Follow-Up not Required; Performance Met: G8783: Normal blood pressure reading documented, follow-up not required Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Documented. Performance Met: G8950: Pre-Hypertensive or Hypertensive blood pressure reading documented, the indicated follow-up is documented Patient not Eligible for measure; Other Performance Exclusion: G8784: Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation, documentation the patient is not eligible) Blood Pressure Reading not Documented, Reason not Given; Performance Not Met: G8785: Blood pressure reading not documented, reason not given Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up not Documented, Reason not Given; Performance Not Met: G8952: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

8 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #12 NQF #0086: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation a. If the Age is greater than or equal to 18 years of age on Date of Service and equals No during the measurement period, do not b. If the Age is greater than or equal to 18 years of age on Date of Service and equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of POAG as Listed in the Denominator equals No, do not b. If Diagnosis of POAG as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check was Optic Nerve Head Evaluation Performed: a. If Optic Nerve Head Evaluation Performed equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the listed at the end of this document. Letter a equals 4 patients in c. If Optic Nerve Head Evaluation Performed equals No, proceed to Documentation of Medical Reason(s) for Not Performing Optic Nerve Head Evaluation. 8. Check Documentation of Medical Reason(s) for Not Performing Optic Nerve Head Evaluation: a.if Documentation of Medical Reason(s) for Not Performing Optic Nerve Head Evaluation equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter b equals 1 patient in the c. If Documentation of Medical Reason(s) for Not Performing Optic Nerve Head Evaluation equals No, proceed to Optic Nerve Head Evaluation Not Performed, Reason Not Specified. 9. Check Optic Nerve Head Evaluation Not Performed, Reason Not Specified: a. If Optic Nerve Head Evaluation Not Performed, Reason Not Specified equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 patients in the c. If Optic Nerve Head Evaluation Not Performed, Reason Not Specified equals No, proceed to Check Reporting Not Met. 10. Check Reporting Not Met: a. If Reporting Not Met, the Quality Data Code or equivalent was not reported. 1 patient has been subtracted from the reporting numerator in sample calculation.

9 NOA 3rd Party Newsletter PQRS EDITION - Page Registry Individual Measure Flow PQRS #141 NQF #0563: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% Documentation of a Plan of Care a. If the Age is greater than or equal to 18 years of age on Date of Service and equals No during the measurement period, do not b. If the Age is greater than or equal to 18 years of age on Date of Service and equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of POAG as Listed in the Denominator equals No, do not b. If Diagnosis of POAG as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check IOP Reduced 15% Pre-Intervention Level: a. If IOP Reduced 15% Pre-Intervention Level equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a1 equals 3 patients in c. If IOP 15% Pre-intervention Level equals No, proceed to Glaucoma Plan of Care Documented IOP Reduced < 15% Pre- Intervention Level. 8. Check Glaucoma Plan of Care Documented IOP < 15% Pre- Intervention Level: a. If Glaucoma Plan of Care Documented IOP < 15% Pre- Intervention Level equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a2 equals 2 patients in c. If Glaucoma Plan of Care Documented IOP < 15% Pre- Intervention Level equals No, proceed to Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified IOP Reduced < 15% Pre-Intervention Level. 9. Check Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified IOP Reduced < 15% Pre-Intervention Level: a. If Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified IOP Reduced < 15% Pre-Intervention Level equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c1 equals 1 patient in the c. If Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified IOP Reduced < 15% Pre-Intervention Level equals No, proceed to IOP Measurement Not Documented, Reason Not Otherwise Specified. 10. Check IOP Measurement Not Documented, Reason Not Otherwise Specified: a. If IOP Measurement Not Documented, Reason Not Otherwise Specified equals Yes, include in the Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c2 equals 1 patient in the c. If IOP Measurement Not Documented, Reason Not Otherwise Specified equals No, proceed to Reporting Not Met. 11. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the reporting numerator in the sample calculation.

10 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #14 NQF #0087: Age-Related Macular Degeneration (AMD): Dilated Macular Examination a. If the Age is greater than or equal to 50 years of age on Date of Service equals No during the measurement period, do not b. If the Age is greater than or equal to 50 years of age on Date of Service equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of AMD as Listed in the Denominator equals No, do not b. If Diagnosis of AMD as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check Dilated Macular Examination Performed Including Documentation of Presence or Absence Macular Thickening or Hemorrhage the Level of Macular Degeneration Severity: a. If Dilated Macular Examination Performed Including Documentation of Presence or Absence Macular Thickening or Hemorrhage the Level of Macular Degeneration Severity equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the listed at the end of this document. Letter a equals 4 patients in c. If Dilated Macular Examination Performed Including Documentation of Presence or Absence Macular Thickening or Hemorrhage the Level of Macular Degeneration Severity equals No, proceed to Documented Medical Reason for not Performing Dilated Macular Examination. 8. Check Documented Medical Reason for Not Performing Dilated Macular Examination: a. If Documented Medical Reason for Not Performing Dilated Macular Examination equals Yes, include in reporting met and performance exclusion. in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter b1 equals 1 patient in the c. If Documented Medical Reason for Not Performing Dilated Macular Examination equals No, proceed to Documented Patient Reason for not Performing Dilated Macular Examination. 9. Check Documented Patient Reason for not Performing Dilated Macular Examination: a. If Documented Patient Reason for not Performing Dilated Macular Examination equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter b2 equals 0 patients in the c. If Documented Patient Reason for not Performing Dilated Macular Examination equals No, proceed to Dilated Macular Examination was Not Performed, Reason Not Otherwise Specified. 10. Check Dilated Macular Examination was Not Performed, Reason Not Otherwise Specified: a. If Dilated Macular Examination was Not Performed, Reason Not Otherwise Specified equals Yes, include in the reporting met and performance not met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 patients in the Sample Calculation. c. If Dilated Macular Examination was Not Performed, Reason Not Otherwise Specified equals No, proceed to Reporting Not Met. 11. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from reporting numerator in the sample calculation.

11 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #140 NQF #0566: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement a. If Age greater than or equal to 50 years of age on Date of Service equals No during the measurement period, do not include in Eligible Patient Population. Stop Processing. b. If Age greater than or equal to 50 years of age on Date of Service equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of AMD as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing. b. If Diagnosis of AMD as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: a. Denominator population is all Eligible Patients in the denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check Age-Related Eye Disease Study (AREDS) Counseling Performed: a. If Age-Related Eye Disease Study (AREDS) Counseling Performed equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter a equals 4 patients in c. If Age-Related Eye Disease Study (AREDS) Counseling Performed equals No, proceed to AREDS Counseling Not Performed, Reason Not Specified 8. Check AREDS Counseling Not Performed, Reason Not Specified: a. If AREDS Counseling Not Performed, Reason Not Specified equals Yes, include in the Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 3 patients in the c. If AREDS Counseling Not Performed, Reason Not Specified equals No, proceed to Reporting Not Met. 9. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the numerator in the sample calculation.

12 NOA 3rd Party Newsletter PQRS EDITION - Page Claims Individual Measure Flow PQRS #19 NQF #0089: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care a. If the Age is greater than or equal to 18 years of age on Date of Service and equals No during the measurement period, do not b. If the Age is greater than or equal to 18 years of age on Date of Service and equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of Diabetic Retinopathy as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing. b. If Diagnosis of Diabetic Retinopathy as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check Dilated Macular or Fundus Exam Findings Communicated to Physician Managing Diabetes Care Dilated Macular or Fundus Exam Performed: a. If Dilated Macular or Fundus Exam Findings Communicated to Physician Managing Diabetes Care Dilated Macular or Fundus Exam Performed equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a equals 4 patients in c. If Dilated Macular or Fundus Exam Findings Communicated to Physician Managing Diabetes Care Dilated Macular or Fundus Exam Performed equals No, proceed to Documentation of Medical Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed. 8. Check Documentation of Medical Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed: a. If Documentation of Medical Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed equals Yes, include in Reporting Met and Performance Exclusion. in the listed at the end of this document. Letter b1 equals 1 patient in the c. If Documentation of Medical Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed equals No, proceed to Documentation of Patient Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed. 9. Check Documentation of Patient Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed: a. If Documentation of Patient Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter b2 equals 0 patients in the c. If Documentation of Patient Reason(s) for Not Communicating Dilated Macular or Fundus Exam findings Dilated Macular or Fundus Exam Performed equals No, proceed to Check Dilated Macular or Fundus Exam Not Performed. 10. Check Dilated Macular or Fundus Exam Not Performed: a. If Dilated Macular or Fundus Exam Not Performed equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter b3 equals 0 patients in the c. If Dilated Macular or Fundus Exam Not Performed equals No, proceed to Dilated Macular or Fundus Exam Findings Not Communicated, Reason not Specified Dilated Macular or Fundus Exam Performed. 11. Check Dilated Macular or Fundus Exam Findings Not Communicated, Reason Not Specified Dilated Macular or Fundus Exam Performed: a. If Dilated Macular or Fundus Exam Findings Not Communicated, Reason Not Specified Dilated Macular or Fundus Exam Performed equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 patients in the c. If Dilated Macular or Fundus Exam Findings Not Communicated, Reason Not Specified Dilated Macular or Fundus Exam Performed equals No, proceed to Reporting Not Met. 12. Check Reporting Not Met a. If Reporting Not Met, the Quality Data Code or equivalent was not reported. 1 patient has been subtracted from the reporting numerator in sample calculation.

13 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #117 NQF #0055: Diabetes: Eye Exam a. If Age equal to 18 thru 75 years of age on Date of Service equals No during the measurement period, do not include in Eligible Patient Population. Stop Processing. b. If Age equal to 18 thru 75 years of age on Date of Service equals Yes during the measurement period, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis of Diabetes as Listed in the Denominator equals No, do not b. If Diagnosis of Diabetes as Listed in the Denominator equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing. b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 5. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 6. Start Numerator 7. Check Dilated Retinal Eye Exam with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed: a. If Dilated Retinal Eye Exam with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a1 equals 1 patient in Sample Calculation. c. If Dilated Retinal Eye Exam with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed equals No, proceed to Seven Standard Field Stereoscopic Photos with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed. 8. Check Seven Standard Field Stereoscopic Photos with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed: a. If Seven Standard Field Stereoscopic Photos with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed equals Yes, include in Reporting Met and Performance Met. Reporting Rate in the Sample Calculation listed at the end of this document. Letter a2 equals 1 patient in the c. If Seven Standard Field Stereoscopic Photos with Interpretation by an Ophthalmologist or Optometrist Documented and Reviewed equals No, proceed to Eye Imaging Validated to Match Diagnosis from Seven Standard Field Stereoscopic Photos Results Documented and Reviewed. 9. Check Eye Imaging Validated to Match Diagnosis from Seven Standard Field Stereoscopic Photos Results Documented and Reviewed: a. If Eye Imaging Validated to Match Diagnosis from Seven Standard Field Stereoscopic Photos Results Documented and Reviewed equals Yes, include in the Reporting Met and Performance Met. Reporting Rate in the Sample Calculation listed at the end of this document. Letter a3 equals 1 patient in the c. If Eye Imaging Validated to Match Diagnosis from Seven Standard Field Stereoscopic Photos Results Documented and Reviewed equals No, proceed to Low Risk for Retinopathy (No Evidence of Retinopathy in the Prior Year). 10. Check Low Risk for Retinopathy (No Evidence of Retinopathy in the Prior Year): a. If Low Risk for Retinopathy (No Evidence of Retinopathy in the Prior Rear) equals Yes, include in the Reporting Met and Performance Met. Reporting Rate in the Sample Calculation listed at the end of this document. Letter a4 equals 1 patient in the c. If Low Risk for Retinopathy (No Evidence of Retinopathy in the Prior Year) equals No, proceed to Dilated Eye Exam was Not Performed, Reason Not Otherwise Specified. 11. Check Dilated Eye Exam was Not Performed, Reason Not Otherwise Specified: a. If Dilated Eye Exam was Not Performed, Reason Not Otherwise Specified equals Yes, include in the Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 3 patients in the c. If Dilated Eye Exam was Not Performed, Reason Not Otherwise Specified equals No, proceed to Reporting Not Met. 12. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the reporting numerator in the sample calculation.

14 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #130 NQF #0419: Documentation of Current Medications in the Medical Record a. If the Age is greater than or equal to18 years of age at Date of Service equals No during the measurement period, do not b. If the Age is greater than or equal to18 years of age at Date of Service equals Yes during the measurement period, proceed to check Encounter Performed. 3. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 4. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 visits in the sample calculation. 5. Start Numerator 6. Check Current Medications List Obtained, Updated, Reviewed and Documented in Medical Record: a. If Current Medications List Obtained, Updated, Reviewed and Documented in Medical Record equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the listed at the end of this document. Letter a equals 4 visits in c. If Current Medications List Obtained, Updated, Reviewed and Documented in Medical Record equals No, proceed to check Current Medications List Not Documented as Obtained, Updated or Reviewed, Patient Not Eligible. 7. Check Current Medications List Not Documented as Obtained, Updated or Reviewed, Patient Not Eligible: a. If Current Medications List Not Documented as Obtained, Updated or Reviewed, Patient Not Eligible equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter b equals 1 visit in c. If Current Medications List Not Documented as Obtained, Updated or Reviewed, Patient Not Eligible equals No, proceed to check Current Medications List Not Documented as Obtained, Updated or Reviewed, Reason Not Given. 8. Check Current Medications List Not Documented as Obtained, Updated or Reviewed, Reason Not Given: a. If Current Medications List Not Documented as Obtained, Updated or Reviewed, Reason Not Given equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 visits in the c. If Current Medications List Not Documented as Obtained, Updated or Reviewed, Reason Not Given equals No, proceed to check Reporting Not Met. 9. Check Reporting Not Met: a. If Reporting Not Met, the Quality Data Code or equivalent was not reported. 1 visit has been subtracted from the reporting numerator in the sample calculation.

15 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #131 NQF #0420: Pain Assessment and Follow-Up a. If the Age is greater than or equal to 18 years of age on Date of Service and equals No during the measurement period, do not b. If the Age is greater than or equal to 18 years of age on Date of Service and equals Yes during the measurement period, proceed to check Patient Encounter 3. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible population. 4. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 visits in the sample calculation. 5. Start Numerator 6. Check Pain Assessment Documented as Positive and Follow- Up Plan Documented: a. If Pain Assessment Documented as Positive and Follow-Up Plan is Documented equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter a1 equals 3 visits in c. If Pain Assessment Documentation is Positive and Follow-Up Plan is Documented equals No, proceed to Pain Assessment Documented as Negative, No Follow-Up Plan Required. 7. Check Pain Assessment Documented as Negative, No Follow- Up Plan Required: a. If Pain Assessment Documented as Negative and No Follow- Up Plan is Required equals Yes, include in Reporting Met and Performance Met. b. Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter a2 equals 1 visit in Sample Calculation c. If Pain Assessment Documented as Negative and No Follow- Up Plan is Required equals No, proceed to Pain Assessment Not Documented, Patient Not Eligible. 8. Check Pain Assessment Not Documented, Patient Not Eligible: a. If Pain Assessment Not Documented, Patient Not Eligible equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter b1 equals 1 visit in c. If Pain Assessment is Not Documented, Patient Not Eligible equals No, proceed to Pain Assessment Documented as Positive, No Follow-Up Plan Documented, Patient Not Eligible. 9. Check Pain Assessment Documented as Positive, No Follow- Up Plan Documented, Patient Not Eligible: a. If Pain Assessment Documented as Positive, No Follow-Up Plan Documented, Patient Not Eligible equals Yes, include in Reporting Met and Performance Exclusion. in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter b2 equals 0 visits in c. If Pain Assessment Documented as Positive, No Follow-Up Plan Documented, Patient Not Eligible equals No, proceed to Pain Assessment Not Documented, Reason Not Given. 10. Check Pain Assessment Not Documented, Reason Not Given: a. If Pain Assessment Not Documented, Reason Not Given equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter c1 equals 0 visits in c. If Pain Assessment Not Documented, Reason Not Given equals No, proceed to Pain Assessment Documented as Positive, Follow-Up Plan Not Documented, Reason Not Given. 11. Check Pain Assessment Documented as Positive, Follow-Up Plan Not Documented, Reason Not Given: a. If Pain Assessment Documented as Positive, Follow-Up Plan Not Documented, Reason Not Given equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate and Performance Rate in the sample calculation listed at the end of this document. Letter c2 equals 2 visits in c. If Pain Assessment Documented as Positive, Follow-Up Plan Not Documented, Reason Not Given equals No, proceed to Reporting Not Met. 12. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 visit has been subtracted from the reporting numerator in the sample calculation.

16 NOA 3rd Party Newsletter PQRS EDITION - Page Claims/Registry Individual Measure Flow PQRS #226 NQF #0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention a. If the Age is greater than or equal to 18 years of age on Date of Service equals No during the measurement period, do not include in Eligible Patient Population. Stop Processing. b. If the Age is greater than or equal to 18 years of age on Date of Service equals Yes during the measurement period, proceed to check Encounter Performed. 3. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible Population. 4. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 5. Start Numerator 6. Check Patient Screened for Tobacco Use, Identified as a User and Received Intervention: a. If Patient Screened for Tobacco Use, Identified as a User and Received Intervention equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a1 equals 1 patient in c. If Patient Screened for Tobacco Use, Identified as User and and Received Intervention equals No, proceed to Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco. 7. Check Patient Screened for Tobacco Use and Identified as a Non- User of Tobacco: a. If Patient Screened for Tobacco Use and Identified as a Non- User of Tobacco equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a2 equals 2 patients in c. If Patient Screened for Tobacco Use and Identified as a Non- User of Tobacco equals No, proceed to Tobacco Screening Not performed for Medical Reason(s). 8. Check Tobacco Screening Not Performed for Medical Reason(s): a. If Tobacco Screening Not Performed for Medical Reason(s) equals Yes, include in Reporting Met and Performance Exclusion. in the listed at the end of this document. Letter b equals 2 patients in the c. If Tobacco Screening Not Performed for Medical Reason(s) equals No, proceed to Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified. 9. Check Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified: a. If Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified equals Yes, include in the Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 patients in the c. If Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified equals No, proceed to Reporting Not Met. 10. Check Reporting Not Met a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the reporting numerator in the sample calculation.

17 NOA 3rd Party Newsletter PQRS EDITION - Page Claims Individual Measure Flow PQRS #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented a. If the Age is greater than or equal to 18 years of age at Date of Service and equals No during the measurement period, do not b. If the Age is greater than or equal to 18 years of age at Date of Service and equals Yes during the measurement period, proceed to check Encounter Performed. 3. Check Encounter Performed: a. If Encounter as Listed in the Denominator equals No, do not b. If Encounter as Listed in the Denominator equals Yes, include in the Eligible Population. 4. Denominator Population: Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation. 5. Start Numerator 6. Check Normal Blood Pressure Reading Documented, Follow-Up Not Required: a. If Normal Blood Pressure Reading Documented, Follow-Up Not Required equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a1 equals 3 patients in the c. If Normal Blood Pressure Reading Documented, Follow-Up Not Required equals No, proceed to Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Documented. 7. Check Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Documented: a. If Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Documented equals Yes, include in Reporting Met and Performance Met. listed at the end of this document. Letter a2 equals 0 patients in the c. If Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Documented equals No, proceed to Patient Not Eligible for Measure. 8. Check Patient Not Eligible for Measure: a. If Patient Not Eligible for Measure equals Yes, include in Reporting Met and Performance Exclusion. b. Reporting Met and Performance Exclusion is represented in the listed at the end of this document. Letter b equals 2 patients in the c. If Patient Not Eligible for Measure equals No, proceed to Blood Pressure Reading Not Documented, Reason Not Given. 9. Check Blood Pressure Reading Not Documented, Reason Not Given: a. If Blood Pressure Reading Not Documented, Reason Not Given equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met is represented in the listed at the end of this document. Letter c1 equals 2 patients in the c. If Blood Pressure Reading Not Documented, Reason Not Given equals No, proceed to Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Not Documented, Reason Not Given. 10. Check Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Not Documented, Reason Not Given: a. If Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Not Documented, Reason Not Given equals Yes, include in Reporting Met and Performance Not Met. b. Reporting Met and Performance Not Met is represented in the listed at the end of this document. Letter c2 equals 0 patients in the c. If Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up Not Documented, Reason Not Given equals No, proceed to Reporting Not Met. 11. Check Reporting Not Met: a. If Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the reporting numerator in the sample calculation.