**ATTENTION ALL PROVIDERS** Medicare Access and CHIP Reauthorization Act (MACRA) SUMMARY

The Final Rule released October 14, 2016 by the Centers for Medicare and Medicaid Services (CMS) finalized the Quality Payment Program (QPP) under MACRA, which replaced the Sustainable Growth Rate (SGR). The QPP has 2 payment tracks for an Eligible Clinician (EC):

• Merit-based Incentive Payment System (MIPS) • Alternative Payment Models (APMs)

Based on an EC’s 2017 reporting year under: MIPS the EC could see a negative, positive, or neutral payment adjustment in 2019. APMs the EC may have a greater reward in 2019, but the EC may also face a greater financial risk

(specifically ECs in Advanced APMs). See Power Point presentation that outlines MACRA requirements in more detail so providers can get started now attached or via https://www.medtronsoftware.com/pdf/Documents/Quality Reporting Presentation.pdf. QUALIFYING ELIGIBLE CLINICIANS:

• Physician • Physician assistant • Nurse practitioner • Clinical nurse specialist • Certified registered nurse anesthetist

EXEMPTIONS: Providers who do not have to report under MACRA:

• Providers in their first year of Medicare Part B participation, OR • Providers who, over the course of one “billing year*”, either:

o Bill less than $30,000 in allowed Medicare Part B charges, OR o See fewer than 100 Medicare Part B Patients

*For 2017, the first “billing year” period reviewed by CMS will be 9/1/2015 through 8/31/2016; The second “billing year” period will be 9/1/2016 through 8/31/2017 NOTE: If a Provider bills less than $30,000, OR sees fewer than 100 Medicare Part B Patients

during either of these periods, the Provider is exempt from reporting. REPORTING UNDER MIPS: In 2017, ECs earn a payment adjustment based on reporting on the following three (3) categories, which comprise an EC’s Composite Performance Score:

• Quality (replaces PQRS) • Improvement Activities (new category) • Advancing Care Information (replaces Meaningful Use) NOTE: A fourth category – Cost – will be implemented beginning in 2018.

PARTICIPATING IN AN APM: (Could be more widely used beginning in 2018) In order to be a Qualifying Participant (QP) and receive a bonus payment through an APM, the EC must participate in an approved/eligible Advanced APM (AAPM), AND must satisfy three (3) factors:

• Use of quality measures comparable to measures under MIPS • Satisfactory use of a Certified EHR Technology (CEHRT), AND • Assume more than a “nominal financial risk” OR is a medical home expanded under the Center for

Medicare and Medicaid Innovation (CMMI) ~ probably on the chopping block due to new administration ~

011817 NEWS BLAST

MACRA Summary Page 2 of 2

ECs that participate in AAPM models but do not meet the factors above can be Partially Qualifying Participants, who will not receive an AAPM bonus payment, but who can elect to participate in or opt out of MIPS.

AS OF JANUARY 1, 2017, MACRA IS NOW IN EFFECT TAKE ACTION NOW: Pick your measures and activities! See attached checklist attached or via https://www.medtronsoftware.com/pdf/Documents/2017 MIPS Reporting Checklist.pdf; this will assist in reporting correctly for MIPS! MEDDATA (MDS) Clients: Complete the attached checklist and send to MDS by February 24, 2017. REMINDER: Sign on to the CMS Enterprise Portal to obtain your Quality and Resource Use Report (QRUR) for 2015 reporting to see if you will be penalized in 2017. [Instructions for signing up for the CMS Enterprise Portal can be found HERE] NOTE: It is not MEDDATA/MEDTRON’s role to monitor client quality reporting.

MEDDATA clients should select a designated staff member to monitor all quality reporting and send status updates to MEDDATA at least quarterly. If, after review, designated staff member determines reporting is lacking, please contact MEDDATA for possible review and assistance.

RESOURCES: Final Rule Executive summary - https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf QPP website - https://qpp.cms.gov/ Contact Software Support for assistance or any questions via:

From MEDPM or MEDEHR Sign On screens, double click on ‘support@medtronsoftware.com’ to compose an email to the Software Support Dept.

-OR- Phone: (985) 234-0599 (local) (800) 978-0599 (toll free)

-OR- Fax: (985) 234-0609

Quality Reporting

Updated: 01/17/17

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The Way It Was… Quality Reporting

• Physician Quality Reporting System • The Physician Quality Reporting System (PQRS) applied bonus

payments (reporting years 2007-2014, bonus payments 2009-2016) to eligible professionals (EP) who satisfactorily reported data on quality measures for covered services provided to Medicare Part B fee-for-service beneficiaries and applied negative payment adjustments (reporting years 2013-2016, payment adjustments 2015-2018) to EPs who failed to satisfactorily report data on quality measures.

• Meaningful Use of the Electronic Health Record • The Medicare Electronic Health Record (EHR) Incentive Program

provides bonus payments to EPs who demonstrate meaningful use (MU) of certified EHR technology and applied negative payment adjustments to those who do not demonstrate.

• Value-based Payment Modifier Program • The Value-Based Payment Modifier (VBPM/VM) Program adjusts payment

rates under the Medicare Physician Fee Schedule based on an EP’s performance on quality and cost categories. 2

REPORTING PERIODS 2007-2016

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2014 REPORTING

IMPACTS 2016 PAYMENTS

2014 Quality Reporting

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IMPACTED 2016 PAYMENTS

PQRS reporting results only available to providers ≅ 2 years later.

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Provider Reporting Results 2014 REPORTING

IMPACTED 2016 PAYMENTS

Via 2016 MREP (Medicare Remit Easy Print):

RARC: N699 – Payment adjustment based on PQRS N700 – Payment adjustment based on EHR N701 – Payment adjustment based on VBPM/VM

http://www.wpc-edi.com/reference/

(CARC)

(CARC)

NOTE: 253 is an additional 2% payment cut.

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2015 REPORTING

IMPACTS 2017 PAYMENTS

Full year report results available (9/2016) via the Quality and Resource Use Reports (QRURs) https://portal.cms.gov.

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2015 PQRS Reporting IMPACTS 2017 PAYMENTS

-OR- Via 2017 MREP remits for payment adjustment codes. No MREP sample yet as Medicare holds payments for 14 days.

To Contest PQRS Results: Informal Review period 09/26/2016 – 11/30/2016 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2015-QRUR.html Nothing can be done to change 2017 PQRS impact. • There are no hardship exemptions for the PQRS negative payment adjustment. • Informal review request were required within 60 days of the September 26, 2016 release

date of the 2015 PQRS feedback reports. Informal review period September 26 - November 30, 2016.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html Contact Help Desk: 1-866-288-8912 (TTY 1-877-715-6222) Email: qnetsupport@hcqis.org

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2015 PQRS Reporting (cont.) IMPACTS 2017 PAYMENTS

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Provider Reporting Results 2015 REPORTING

IMPACTED 2017 PAYMENTS

To Contest EHR Results: NOTE: CMS Meaningful Use (MU) Letters were received ~12/27/16

notifying providers of 2017 EHR (MU) payments adjustments.

EPs who believe they erroneously received a negative payment adjustment for failing to demonstrate MU in 2015 can apply for a Hardship Exception by submitting a Reconsideration Form. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_ReconsiderationFormEP.pdf EHR DEADLINE IS FEBRUARY 28, 2017

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2016 REPORTING

IMPACTS 2018 PAYMENTS

2016 PQRS Reporting 2016 reporting requirements: • Full year of reporting (January 1 – December 31, 2016)

• Report on at least 9 measures (including 1 cross-cutting measure)

across 3 domains for at least 50% of the Medicare Part B patients

• Cross-cutting measures are any measures that are broadly applicable across multiple clinical settings and eligible professionals (EPs) or group practices within a variety of specialties.

• In early 2011, the Agency for Healthcare Research and Quality (AHRQ) delivered the National Quality Strategy (NQS) to Congress.

IMPACTS 2018

PAYMENTS

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• The AHRQ/NQS strategy included three aims and six priorities whose intent was to focus our collective attention on:

Quality and the measurement of quality within health care.

• Those six priorities have morphed into what we now referred to as the six NQS domains.

• Patient Safety • Patient and Family Engagement • Care Coordination • Clinical Processes/Effectiveness • Population and Public Health • Efficient Use of Healthcare Resources

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2016 PQRS Reporting (cont.) IMPACTS 2018 PAYMENTS

What can a provider do now to fix 2016 reporting.

• Claims reporting: Nothing. (get all your charges with Cat II codes filed by deadline)

• Registry Reporting: – Review results to see if Cat II numerators can be added to data for recalculation. – Confirm the last day to send data to your specific registry. – Review the list of Qualified Registries to see if participation is still available:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2016QualifiedRegistries.pdf

• EHR Reporting: – Attest to a 90 day period in 2016 and submit data by deadline.

• Last date to submit data to CMS:

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2016 PQRS Reporting (cont.) IMPACTS 2018 PAYMENTS

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2017 REPORTING

IMPACTS 2019 PAYMENTS

2017 THE CHANGE (more acronyms)

MACRA: Medicare Access and CHIP Reauthorization Act

• CHIP: Children’s Health Insurance Program

• SGR: Sustainable Growth Rate

• QPP: Quality Payment Program CMS (Centers for Medicare and Medicaid Services) is replacing the long standing SGR provider fee schedule system used prior to 2017 to calculate physician reimbursement based on an economic growth formula resulting in a conversion factor (CF) threat of a ~20% cut each year.

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QPP will change physician reimbursement from quantity to quality by establishing two tracks for quality reporting (provider picks):

• MIPS: Merit Based Incentive Payment (most widely used by providers) – Will potentially provide incentive payments to ECs for participation

• APM: Alternative Payment Model (may be more widely used by 2018) Eligible Clinicians (EC) (previously called Eligible Professionals (EP)):

• Physician (MD/DO and DMD/DDS) • Physician Assistant (PA) • Nurse Practitioner (NP) • Clinical Nurse Specialist (CNS) • Certified Registered Nurse Anesthetist (CRNA)

2019 (3rd year of QPP reporting) to broaden ECs to include: • Physical (PT) / Occupational Therapist (OT) • Speech/Language Therapist (SLP) • Audiologists • Nurse Midwives • Clinical Social Workers • Clinical Psychologists • Dietitians / Nutritional Professionals

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Exempt providers: Based on CMS analysis of a providers historical data from a billing / determination period: September 1, 2015 – August 31, 2016 OR September 1, 2016 – August 31, 2017 Exempt providers include:

• Providers who see less than 100 Medicare patients OR

• Providers who bill (submit claims for) less than $30,000 • Submitted claims* yielding Medicare ‘Allowed’ amount

OR • Newly enrolled providers

• Enrolled in Medicare in 2017 (not reenrolled, true first time enrolled)

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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(recall MREP sample)

CMS will notify provider,

no action necessary

Reporting Requirements

Must report on at least 50% of the clinician or group’s patients who meet the measure’s denominator criteria for the performance period. • Individuals or groups who submit Quality measure data using QCDRs,

qualified registries, or via EHR: CMS will expect to receive Quality data for both Medicare and non-Medicare patients.

• Individual MIPS eligible clinicians who submit Quality measure data on Medicare Part B claims (claims reporting):

CMS will expect to receive Quality data for Medicare patients only.

NOTE: The Medicare Remit Easy Print (MREP) conveys CARCs and RARCs of numerator acceptance, i.e.,

N620 - Alert: This procedure code is for quality reporting / informational purposes only.

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Provider Reporting Acknowledgment Via MREP (Medicare Remit Easy Print):

RARC: N620 – Alert: This procedure code is for quality reporting/informational purposes only. http://www.wpc-edi.com/reference/

(CARC)

(CARC)

Why act now?

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Possibility of more timely feedback and protecting future fee schedule.

MIPS: Merit Based Incentive Payments – Four reporting options:

• Submit Something neutral fee schedule adjustment Avoid the payment penalty in 2019

• Submit a Partial Year + positive fee schedule adjustment Avoid the payment penalty in 2019 Become eligible for a partial positive adjustment • Submit a Full Year ++ positive fee schedule adjustment Avoid the payment penalty in 2019 Become eligible for a moderate positive adjustment • Don’t Participate negative fee schedule adjustment Receive a -4% payment penalty in 2019

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Track 1: MIPS - Four categories to calculate a providers 2017 composite performance score (possible 100 points)

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

Categories (https://qpp.cms.gov) • Quality – All ECs • Clinical Practice Improvement Activities (CPIA) – All ECs • Advancing Care Information (ACI) – See exemptions • Cost (not used until 2018) - Deferred

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Quality Category • Replaces Physician Quality Reporting System (PQRS) • Accounts for 60% of the ECs performance score

• Could account for 85% if EC is ACI category exempt • 271 available measures including 30 specialty measure sets • Each measure worth up to 10 points (see decile)

• Each measure earns up to 10 points based upon the percentile-basis performance of that measure relative to national peer benchmarks

• Report 6 measures including: • An High Priority Measure (outcome measure)

OR • One Specialty Measure Set

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Advancing Care Improvements (ACI) Category • Replaces EHR Meaningful Use • Accounts for 25% of performance score (non-exempt ECs) • 2 options with 11-15 available measures • Must fulfill the required measures for a minimum of 90 days:

• Security Risk Analysis • e-Prescribing • Provide Patient Access • Send Summary of Care • Request/Accept Summary of Care

• Earn additional credit by submitting any combination of Medium/High Weighted Measures (submit up to 9 measures) • Each Medium weight measure worth 10 points • Each High weight measure worth 20 points

Providers who meet the ‘low-volume’ threshold or meet the definition of a ‘hospital based clinician’ or ‘non-patient facing clinician’ may be exempt from reporting the ACI measures. (see next slide)

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Advancing Care Improvements (ACI) Category (exemptions cont.) Providers exempt from reporting ACI category measures, i.e., ACI weight of zero, shifts the 25% weight to Quality category: • ‘Hospital Based Clinician’ –

Defined as an EC who furnishes 90% or more of his/her covered professional services in sites of service for inpatient hospital or emergency room in the year preceding the performance period. Anesthesiologists, CRNAs, Radiologists, Pathologists may be classified as hospital based ECs.

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Advancing Care Improvements (ACI) Category (exemptions cont.) Providers exempt from reporting ACI category measures, i.e., ACI weight of zero, shifts the 25% weight to Quality category: • ‘Non-Patient Facing Clinician’ –

Defined as an individual that bills 100 or fewer patient-facing encounters (or a group in which more than 75% of the NPIs billing under the group’s TIN meet the definition of a non-patient facing individual MIPS eligible clinician) during a performance period (one calendar year). Under this rule, CMS considers a ‘patient-facing encounter’ as an instance in which the MIPS eligible clinician or group billed for services such as general office visits, outpatient visits, and surgical procedure codes under the Medicare Physician Fee Schedule. Anesthesiologists, CRNAs, Radiologists, Pathologists may be classified as non patient facing ECs.

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Clinical Practice Improvement Activities (CPIA/IA) Category • New concept • Accounts for 15% of the EC’s performance score • 93 available activities • Each Medium Weight activity worth 10 points • Each High Weight activity worth 20 points • Earn 20 points using any combination of medium/high weighted activities

by attesting that you completed up to 4 improvement activities

Providers who meet the definition of a ‘non-patient facing clinician’ may have reduced reporting requirements, i.e., only have to report 1 high weighted activity or 2 medium weighted activities. (see previous slide)

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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A provider’s Performance Threshold (PT)/Composite Performance Score (CPS) is calculated based on the provider’s reporting of the Quality Payment Program (QPP) categories. Each year, CMS sets a performance threshold, i.e., the number of points a provider must achieve to maintain a neutral Medicare Part B fee schedule. For 2017, CMS has set the below performance threshold to significantly reduce a provider’s chance of being penalized for low performance during the transition year:

• Performance threshold 3 points • Exceptional performance threshold 70 points

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Providers Final Score

Payment Adjustment

0 Points Negative payment adjustment of -4% 0 Points = Provider did not participate

3 Points Neutral payment adjustment

4 - 69 Points Positive payment adjustment The threshold for these payment adjustments will be the mean or median composite score for all MIPS eligible clinicians during the previous performance period

Not eligible for exceptional performance bonus

70+ Points Positive payment adjustment Eligible for exceptional performance bonus – minimum of additional 0.5%

Track 2: APM: Alternative Payment Model (APM) (https://qpp.cms.gov/learn/apms)

• An APM is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care.

• APMs can apply to a specific clinical condition, a care episode, or a population.

• Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes.

• ECs may earn a 5% incentive payment by going further in improving patient care and taking on financial risk through an Advanced APM.

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Goal is to reduce healthcare costs by rewarding “better care” instead of volume and adjust a provider’s fee schedule or based on the Quality reporting. • No more annual SGR “doc fix” panic at year end to lower fee schedule

for increased Medicare expenditures.

• New system is expected to be budget-neutral: it is meant to reduce reimbursement for those not performing (the “have nots”) to pass along these savings to those performing (the “haves”).

• MIPS goal of 90% of fee for service payments tied to quality or value by the end of 2018 reporting year.

What is the Government Doing?

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Why Should You Care?

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THANK YOU

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Were Your 2016 Services Reduced by Your 2014 Reporting? PQRS, EHR, and VM penalties use CARC: 237 – Legislated/ Regulatory Penalty (LRP) to designate when a reduction to the provider’s fee schedule is applied.

The associated RARC code designates the program: RARC: N699 – Payment adjustment based on PQRS RARC: N700 – Payment adjustment based on EHR RARC: N701 – Payment adjustment based on VBPM/VM

NOTE: CARC: 253 represents an additional 2% payment reduction for the Sequestration - Reduction in Federal Spending.

Let’s review your 2016 Medicare Remits via MREP (Medicare Remit Easy Print). 35

2015 PQRS Reporting 2015 reporting requirements: • Full year of reporting (January 1 – December 31, 2015)

• Report on at least 9 measures (including 1 cross-cutting measure)

across 3 domains for at least 50% of the Medicare Part B patients

• Cross-cutting measures are any measures that are broadly applicable across multiple clinical settings and eligible professionals (EPs) or group practices within a variety of specialties.

• In early 2011, the Agency for Healthcare Research and Quality (AHRQ) delivered the National Quality Strategy (NQS) to Congress.

IMPACTS 2017

PAYMENTS

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2016 EHR Reporting 2016 reporting requirements: • The Medicare EHR Incentive Program provides bonus payments to

EPs who demonstrate MU of certified EHR technology.

• The cumulative payment amount depends on the year in which a professional begins participating in the program.

• EPs whose EHR participation started in: • 2013 may receive up to $38,220 • 2014 may receive up to $23,520

• The last year to begin participation and be eligible for incentive payments in the Medicare program was 2014 / Medicaid was 2016.

• Negative payment adjustments (fee schedule reduced) for those who did not demonstrate MU of EHR began in 2015.

IMPACTS 2018

PAYMENTS

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Track 1: Merit Based Incentive Payment (MIPS) • MIPS allows reporting as an individual or group. • ECs must choose to report consistently across all categories:

• Quality • Clinical Practice Improvement Activities (CPIA) • Advancing Care Information (ACI) • Cost (not used until 2018)

• Reporting Period: Continuous 90 day period in 2017 (minimally) https://qpp.cms.gov/ http://codingleader.com/blogs/compliancepop/group-or-individual

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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Reporting as an Individual • If MIPS data sent in as an individual, the payment adjustment will be

based on individual providers performance.

• An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number.

• Send individual data for each of the MIPS categories through: • Certified electronic health record • Registry (Submit data for MIPS measures only) • Qualified clinical data registry (Submit data for MIPS and other measures) • Traditional Medicare claims (claims reporting)

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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The Quality Payment Program (QPP) lists the following CMS programs as Advanced APMs: • Medicare Shared Savings Program

(two-sided models: Tracks 2 and 3) • Next Generation ACO Model • Comprehensive ESRD Care (CEC) (large dialysis organization arrangement) • Comprehensive Primary Care Plus (CPC+) • Oncology Care Model (OCM) (two-sided risk track available in 2018) Clinicians in entities sufficiently participating in Advanced APMs will also receive an annual 5% Medicare Part B bonus.

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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• Includes 4 payment models run by CMS (not by commercial payers): • CMS Innovation Center Model (other than a Health Care Innovation Award) • Medicare Shared Savings Program Accountable Care

Organizations (MSSP ACOs) • Demonstration under the Health Care Quality Demonstration

Program • Demonstration required by federal law

• The subset of APMs known as Advanced APMs must fulfill these additional requirements: • Requires participants to use certified EHR technology • Bases payment on quality measures comparable to those in the

MIPS Quality performance category • Either APM entities must bear more than nominal financial risk for

monetary losses or the APM is a Medical Home Model expanded by the CMS Innovation Center

2017 MACRA Reporting (cont.) IMPACTS 2019 PAYMENTS

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MACRA – 2017 MIPS REPORTING CHECKLIST

Page 1 of 2 F:\Admin Services\MDS\2017 MIPS Reporting Checklist.docx

Designated Staff Member: _____________________________ Email: ______________________________ Select How Much You Will Report: Submit Something neutral fee schedule adjustment; avoid the payment penalty in 2019

Submit a Partial Year + positive fee schedule adjustment; avoid the payment penalty in 2019;

become eligible for a partial positive adjustment

Submit a Full Year ++ positive fee schedule adjustment; avoid the payment penalty in 2019; become eligible for a moderate positive adjustment

Don’t Participate negative fee schedule adjustment; receive a -4% payment penalty in 2019

Exempt less than $30,000 OR less than 100 Medicare patients OR 1st year billing to Medicare (circle one option above -- no further action needed to complete this checklist)

Select Your Data Submission Method, i.e., How You Will Report: Report on at least 50% of the patients who meet the measure denominator criteria for the performance period. Using Qualified Clinical Data Registry (QCDR), qualified registries, or via EHR;

Medicare and non-Medicare patients o List specific option: ________________________

Claims reporting; Medicare patients only

Select Quality Measures: https://qpp.cms.gov/measures/quality Report 6 measures including 1 High Priority Measure (Outcome Measure)

OR Report 1 Specialty Measure Set

Select Advancing Care Improvement (ACI) Measures: https://qpp.cms.gov/measures/aci Exemption Hospital Based Clinician Non Patient Facing Clinician

OR Fulfill the 5 required measures for a minimum of 90 days Security Risk Analysis (SRA) Conduct or review a SRA, including addressing the security (to include

encryption) of ePHI data created or maintained by certified EHR technology, and implement security updates as necessary and correct identified security deficiencies as part of the MIPS EC’s risk management process

MACRA – 2017 MIPS REPORTING CHECKLIST

Page 2 of 2 F:\Admin Services\MDS\2017 MIPS Reporting Checklist.docx

e-Prescribing At least one permissible prescription written by the MIPS EC is queried for a drug

formulary and transmitted electronically using certified EHR technology

Provide Patient Access For at least one unique patient seen by the MIPS EC: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS EC ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS EC’s certified EHR

Send Summary of Care For at least one transition of care or referral, the MIPS EC that transitions or refers their patient to another setting of care or health care provider (1) creates a summary of care record using certified EHR; and (2) electronically exchanges the summary of care record

Request/Accept Summary of Care For at least one transition of care or referral received or patient encounter in which the MIPS EC has never before encountered the patient, the MIPS EC receives or retrieves and incorporates into the patient's record an electronic summary of care document

Submit up to 9 additional measures (for additional credit) Clinical Data Registry Reporting Clinical Information Reconciliation Electronic Case Reporting Immunization Registry Reporting Patient-Generated Health Data Patient-Specific Education Public Health Registry Reporting Secure Messaging Syndromic Surveillance Reporting View, Download and Transmit (VDT)

Complete Clinical Practice Improvement Activities (CPIA/IA): https://qpp.cms.gov/measures/ia Earn 20 points using any combination of Medium/High Weighted activities by attesting that you completed up to 4 improvement activities

OR Non Patient Facing clinicians, report 1 High Weighted activity or 2 Medium Weighted activities