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2013 EHR INCENTIVE PROGRAM MANUAL

2013 EHR Incentive Program Manual

Table of Contents

INTRODUCTION TO EHR & MEANINGFUL USECMS’ EHR INCENTIVE PROGRAM - PARTICIPATION COMPARISON - MEDICARE & MEDICAID PROGRAMSTHE 2013 MEDICARE EHR INCENTIVE PROGRAM INCENTIVE PAYMENTS & PENALTY ADJUSTMENTSINCENTIVE PAYMENTS & PENALTY ADJUSTMENTSINCENTIVE P

HARDSHIP EXEMPTIONS 2013 REQUIREMENTS FOR REPORTING MEANINGFUL USE

EHR SYSTEM CERTIFICATION STAGE 1 OBJECTIVE REQUIREMENTSSTAGE 1 OBJECTIVE REQUIREMENTSST CLINICAL QUALITY MEASURES

EHR PROGRAM REGISTRATION & ATTESTATIONEHR PROGRAM REGISTRATION & ATTESTATIONEHR PROGRAM REGISTRA2014 STAGE 2 REQUIREMENTS2014 STAGE 2 REQUIREMENTS2014 ST ADDENDUM 1 – STAGE 2 OBJECTIVESADDENDUM 1 – STAGE 2 OBJECTIVESADDENDUM 1 – ST

ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES

EHR INCENTIVE PROGRAM MANUAL

Thismanualcontainsinformationforthe2013EHRIncentiveProgramforphysiciansandclini-

cians,referredtobyCMSaseligibleprofessionalsorEPs.(Hospitalsparticipateintheirownver-

sionoftheprogram)UpdatestoStage1,handeddownintheStage2rulingonAugust23,2012,

areincludedinthismanual.

Stage2oftheprogramdoesnotbeginuntilJanuary1,2014.Wehaveincludedsomeinformation

onStage2attheendofthemanual.However,thismanualisprimarilydesignedforEPspartici-

patingintheprogramin2013.

INTRODUCTION TO EHR (ELECTRONIC HEALTH RECORDS) & MEANING-FUL USE (MU)

TheAmericanRecoveryandReinvestmentActof2009(RecoveryAct)(ARRA)wassignedintolaw

byPresidentObamaonFebruary17,2009.ThelawincludestheHealthInformationTechnology

forEconomicandClinicalHealthAct,orthe“HITECHAct,”whichestablishedprogramsunder

MedicareandMedicaidtoprovideincentivepaymentsforthe“meaningfuluse”or“MU”ofcerti-

fiedelectronichealthrecords(EHR)technology.

OnDecember20,2009,CMS(TheCentersforMedicareandMedicaid)and ONC(OfficeoftheNa-

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tionalCoordinatorforHealthInformationTechnology)issuedtworegulationsthatlaidthefoun-

dationforimprovingquality,efficiencyandsafetythrough“meaningfuluse”ofcertifiedelectronic

healthrecords(EHR)technology.

TheCMS’ regulation:

•DefinesandspecifieshowtodemonstrateMUofEHRtechnology,whichisapre-requi-

siteforreceivingtheMedicareorMedicaidincentivepayments.

•OutlinestheproposedpaymentmethodologiesforboththeMedicareandMedicaidin-

centiveprograms.

TheONC regulation:

•Setsinitialstandards,

•Implementsspecificationsand

•CreatescertificationcriteriaforEHRtechnologythatshouldenhancetheinteroperabil-

ity,functionality,utilityandsecurityofhealthinformationtechnology.

The Recovery Act specifies the following 3 components of Meaningful Use:

1.UseofcertifiedEHRinameaningfulmannerwhichincludes:

a.theabilitytoelectronicallycapturehealthinformationinacodedformat,

b.usageofthatinformationtotrackkeyclinicalconditions,

c.implementationofclinicaldecisionsupporttoolstofacilitatediseaseandmed-

icationmanagement,and

d.theabilitytoreportclinicalqualitymeasuresandpublichealthinformation

2.UseofcertifiedEHRtechnologyforelectronicexchangeofhealthinformationtoim-

provequalityofhealthcarewhichincludes:

a. exchanginghealthdataamongproviders,

b.providingsecurityofthatdata

3. UseofcertifiedEHRtechnologytosubmitclinicalqualitymeasures(CQM)andother

suchselectedmeasureswhichincludes:

a.usingstandardformatsforclinicalsummariesandprescriptionsandstandard

termstodescribeclinicalproblems,proceduresandtests

EHR IMPLEMENTATION STAGESInJuly2010,CMSissuedafinalrulefortheElectronicHealthRecordsIncentiveProgramfor

Medicare and Medicaid, establishing a three-phase approach to implementing the require-

mentsfordemonstratingmeaningfuluse.Stage1wouldbeginonJanuary1,2011andthrough

arecentrulingwasextendedthrough2013. Stage2wasfinalizedbybothCMSandONCon

August23,2012tobeginonJanuary1,2014.Stage3isnowinthedesignstageandisslatedto

befinalizedin2016.

• Stage 1-meaningfulusecriteriafocusesonelectronicallycapturinghealthinformation

inacodedformat,usingthatinformationtotrackkeyclinicalconditionsandcommu-

nicatingthatinformationforcarecoordinationpurposes.Italsocallsforimplementing

clinicaldecisionsupport tools to facilitatediseaseandmedicationmanagementand

reportingclinicalqualitymeasuresandpublichealthinformation.

•Stage 2 -expandsupontheStage1criteriatoencouragetheuseofhealthITforcon-

tinuousquality improvementat thepointofcareand theexchangeof information in

themoststructuredformatpossible,suchastheelectronictransmissionofordersen-

teredusingcomputerizedproviderorderentry(CPOE)andtheelectronictransmission

ofdiagnostictestresults(suchasbloodtests,microbiology,urinalysis,pathologytests,

radiology,cardiacimaging,nuclearmedicinetests,pulmonaryfunctiontestsandother

suchdataneededtodiagnoseandtreatdisease).Additionallytheymayconsiderapply-

ingthecriteriamorebroadlytoboththeinpatientandoutpatientsettings.

•Stage 3-focusesonpromotingimprovementsinquality,safetyandefficiencyandon

decisionsupportfornationalhighpriorityconditions,patientaccesstoselfmanage-

menttools,accesstocomprehensivepatientdataandimprovingpopulationhealth.

THE 2013 EHR INCENTIVE PROGRAM - PARTICIPATION

InordertoencouragetheuseofEHRsystemsinthemedicalcommunity,Medicare&Medicaid

willprovide incentivepaymentstoeligibleprofessionalsthataremeaningfulusersofcertified

EHRsystemsinordertohelpdefraythecostofinstitutingacceptableEHRsystems.Thepartici-

pationregulationsforEPsintheMedicareandMedicaidprogramsare:

1.AnEPcanonlyparticipateineithertheMedicareorMedicaidprogram–notboth.How-

ever,aftertheinitialdesignationtoapplyforeithertheMedicareorMedicaidincentive,

EPsareallowedtochangetheirselectiononceduringpaymentyears2012-2014.

2.MedicareEligibleProfessionals’Criteria

a.Physicians-DoctorsofMedicineorOsteopathy,DentalSurgery/Medicine,Po-

diatristsMedicine,Optometry&Chiropractors

b.HospitalbasedEPsdoNOTqualifyforMedicareEHRincentivepayments.A

hospitalbasedEP isonewhofurnishes90%ormoreof theirservices inan

inpatientoremergencyroomhospitalsetting.


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c.Toreceivethemaximumincentive,anEPmustbeginparticipationby2012

3. MedicaidEligibleProfessionals’Criteria

a.Physicians – primarily medicine and osteopathy (Pediatricians have special

eligibility&paymentrules)

b.NursePractitioners(NPs),CertifiedNurse-Midwives,Dentists,

c. PhysicianAssistantswhopracticeinaFederallyQualifiedHealthCenter(FQHC)

orRuralHealthCenter(RHC)thatisledbyaPhysicianAssistant.

d. Medicaidpopulationmustbe30%ofanEPstotalpatientvolume (billeden-counters)toqualifyfortheMedicaidincentiveprogram(20%forpediatricians)

e.AnEPthatpracticespredominantlyinanFQHCorRHCandhavea30%patient

volumeattributabletoneedyindividuals

f.Children’s’HealthInsurancePrograms(CHIP)donotcounttowardstheMedic-

aidpatientvolume

4. MedicareAdvantage(MA)IncentiveCriteria

a.PaymentsmaybemadetoqualifyingMAorganizations(MAO)fortheiraffiliated

EPswhoaremeaningfulusersofcertifiedEHRtechnology.SpecificallyanMA

EPmusteither:

i.Furnish,onaverage,at least20hours/weekofpatient-careservices

andbeemployedbythequalifyingMAO,or

ii.Beemployedby,orbeapartnerof,anentitythatthroughcontractwith

thequalifyingMAOfurnishesatleast80percentoftheentity’sMedi-

carepatientcareservicestoenrolleesofthequalifyingMAO

5.IfanEPprovidesservicesinmorethanonepracticeorlocation,50%ormoreofthe

EP’spatientencountersmustbeinapractice(s)orlocation(s)equippedwithcertified

EHRtechnology.

Example: IfanEPworks in3practices/locationsand2of the3havecertifiedEHR

technology,50%ormoreoftheEP’spatientencountersmustoccuratthe2locations

thathavecertifiedEHRtechnology.

6.EPswhoseepatientsinbothinpatient/ERandoutpatientsettingsandcertifiedEHR

technologyisavailableateachlocation,theEPsmustbasetheirmeaningfulusecal-

culationsonpatientsinonlytheoutpatientsetting(s).

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COMPARISONS OF MEDICARE & MEDICAID EHR PROGRAMS

LIMITATIONS OF PARTICIPATION IN MULTIPLE INCENTIVE PROGRAMS

THE MEDICARE EHR INCENTIVE PLAN

NOTE:AsmostofourclientswillnotparticipateintheMedicaidIncentiveProgram,theremain-

derof thismanualwill focusonlyontheMedicareIncentiveProgram.Those interested inthe

Medicaid IncentiveProgramshouldvisitCMS’EHR IncentiveProgramwebsiteandreview the

EHR BasicsandMedicaid State Informationsubcategories.

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NOTABLE DIFFERENCES BETWEEN THE MEDICARE & MEDICAID EHR PROGRAMS

MEDICARE

Run by CMS

$44,000 Maximum Incentive Payment per EP - Payments over 5 consecutive years (2011 & 2012), reduced pay-ments over less years for 2013 - 2016

Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate

Providers must demonstrate meaningful use every year to receive incentive payments.

Last year EP can initiate program is 2014

Last payment year in program is 2016

Payment adjustments begin in 2015

Only Physicians

MEDICAID

Run by Your State Medicaid Agency

$63,750 Incentive Payment per EP - Payments over 6 years, does not have to be consecutive

No Medicaid payment adjustments

In the first year providers can receive an incentive pay-ment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments

Last year EP can initiate program is 2016

Last payment year in program is 2021

No Payment adjustments

5 Types of EPs

PARTICIPATION IN HITECH AND OTHER MEDICARE INCENTIVE PROGRAMS

OTHER EHR MEDICARE INCENTIVE PROGRAM

PQRS

eRx (E-prescribe)

eRx (E-prescribe)

ELIGIBLE FOR HITECH?

Yes, EPs can participate in both if eligible

No - if the EP chooses to participate in the MEDICARE EHR Incentive Program, they cannot participate in the eRx program simultaneously

Yes - If the EP chooses to participate in the MEDICAID EHR Incentive program

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/50_Registration.asp#TopO


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ToqualifyforMedicareincentivepayments,theEPmustmeaningfullyusecertifiedEHRtech-

nologyforthedurationoftheEHRreportingperiodoftherelevantpaymentyear.Thereporting

periodmaybeanycontinuous90-dayperiodormorewithinthefirstpaymentyear,andtheentire

calendaryearforallsubsequentyears.Example:IftheEPwantedtoreportfortheyear2013,the

lastreportingperiodfor2013wouldbeginonOctober1,2013.

Intheoriginalfinalrule,CMShadestablishedatimelinethatrequiredproviderstoprogressto

Stage2criteriaaftertwoprogramyearsundertheStage1criteria.Thisoriginaltimelinewould

haverequiredMedicareproviderswhofirstdemonstratedmeaningfuluse in2011tomeetthe

Stage2criteriain2013.

UndertherecentStage2FinalRule,CMSdelayedtheonsetofStage2criteriaforEPsuntilfiscal

year2014.ThisallowsproviderswhofirstdemonstratedMUin2011tohavethreeconsecutive

yearsofMUundertheStage1criteriabeforeadvancingtoStage2criteria.Allotherproviders

wouldmeettwoyearsofmeaningfuluseundertheStage1criteriabeforeadvancingtotheStage

2criteriaintheirthirdyear.

•FirstYearofparticipation–providersmustdemonstrateMUfora90-DayEHRreportingperiod.

•Subsequentyears-fullyearreportingperiod(entirecalendaryear),exceptfor2014

In theStage2 ruling,CMSmadeanexception for the year2014 requiringonlya three-month

reportingperiodforthatyearinorderforEPstomakethenecessarychangestotheirsystems,

regardlessoftheirstageofMU.Thethree-monthEHRreportingperiodisfixedtocalendaryear

quartersinordertoalignwithexistingCMSqualitymeasurementprogramssuchasPQRS.2014is

theonlytimeCMSwillpermitthisthree-monthreportingperiod.Thefollowingtableillustratesthe

progressionofMUstagesfromwhenaMedicareproviderbeginsparticipationwiththeprogram.

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1st Year STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR

STAGE OF MEANINGFUL USE BY FIRST MEDICARE PAYMENT YEAR

2011

2012

2013

2014

2015

2016

2017

2011

1

2012

1

1

2013

1

1

1

2014

2

2

1

1

2015

2

2

2

1

1

2016

3

3

2

2

1

1

2017

3

3

3

2

2

1

1

2018

TBD

TBD

3

3

2

2

1

2019

TBD

TBD

TBD

3

3

2

2

2020

TBD

TBD

TBD

TBD

3

3

2

2013

TBD

TBD

TBD

TBD

TBD

3

3

PAYMENT & ADJUSTMENT PROVISIONS OF THE EHR INCENTIVE PLAN

MEDICARE PAYMENT INCENTIVES

Paymentprovisionsforqualifiedprovidersareasfollows:

•Providersmayearnincentivepaymentequalto75%oftheirMedicareallowedcharges

forcoveredservicesfurnishedbytheproviderinayear,subjecttothemaximumpay-

mentasstatedinthefollowingchart.

•ThoseEPswhoattestandsuccessfullyadoptMUin2011and2012aretheonlyEPswho

willreapthehighestincentiveof$44,000perEP.ProvidershaduntilOctober1,2012to

demonstrate90daysofMUwiththeirEHRtoqualifyforthefull$44,000per-provider

Medicarebonus.

•Thosewhobegintheprocessin2013canearnamaximumof$39,000andin2014,$24,000.

•TherewillbenoincentivepaymentstoEPswhofirstbecomemeaningfulEHRusersin

2015orthereafter.

Additional incentives are made for Medicare EPs practicing in HPSAs. (Health ProfessionalShortageArea)

MEDICARE PAYMENT ADJUSTMENTS (PENALTIES)

For2015andlater,MedicareEPswhoarenotmeaningfulusersofCertifiedEHRtechnologyby

2014willfaceMedicarepaymentreductionsin2015.(unlesstheEPissuccessfullyparticipating

intheMedicaidEHRIncentiveProgram)

EPswhofirstdemonstratedMUin2011or2012mustdemonstrateMUforafullyearin2013to

avoidpaymentadjustmentsin2015andmustcontinuetodemonstrateMUeveryyeartoavoid


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MEDICARE & MAO FIRST CALENDAR YEAR IN WHICH EP RECEIVES INCENTIVE PAYMENT

CALENDAR YEAR

2011

2012

2013

2014

2015

2016

TOTAL

2011

$18,000

$12,000

$8,000

$4,000

$2,000

$44,000

2012

$18,000

$12,000

$8,000

$4,000

$2,000

$44,000

2013

$15,000

$12,000

$8,000

$4,000

$39,000

2014

$12,000

$8,000

$4,000

$24,000

2015 & later

$0

$0

$0

paymentadjustmentsinsubsequentyears.

ThepaymentadjustmentswillbeappliedtotheMedicarephysicianfeeschedule(PFS)amount

forcoveredprofessionalservicesfurnishedbytheEPduringtheyear.Thepaymentadjustment

is1%peryearandiscumulativeforeveryyearanEPisnotameaningfuluser.For2018and

thereafter,ifitisfoundthattheproportionofproviderswhoareMedicareEHRusersislessthan

75%,thenreductionswillincreaseby1%eachyearbutnotbymorethan5%overall.Payment

adjustmentswillbeasfollows:

•1%in2015,

•2%in2016,

•3%in2017,

•4%in2018,and

•between3-5%insubsequentyears.

HARDSHIP EXEMPTIONS

Inthe“proposed“Stage2period,inadditiontothoseEPswhopetitionedCMSandONCtonot

penalizeEPsinunusualcircumstances,manyspecialtyorganizationspetitionedCMSandONC,

torefocustheEHRobjectivesorexemptthemfromtheprogramastheprogram’sobjectives

favoredprimarycareanddidnotmatchtheirspecialties’environment.Theresultofbothre-

questswasthecreationoffourhardshipexemptionsinthefinalStage2ruling.Thesehardship

exemptionswillbegrantedonlyunderspecificcircumstancesandonlyifCMSdeterminesthat

providershavedemonstratedthatthosecircumstancesposeasignificantbarriertotheirachiev-

ingMU.Thefourexemptionsare:

• Infrastructure:Cliniciansmustprove that theypractice inanareawith inadequate

internetaccessor“insurmountablebarriers”toobtainingit

• New Practitioners:Clinicianswhobeginpracticingin2015wouldbeexemptfromthe

MUpenaltyin2015and2016,butwouldhavetodemonstrateMUin2016toavoidthe

penaltyin2017.

• Unforeseen Circumstances:Naturaldisasterorsomeotherunforeseeableeventthatpre-

ventsmeetingEHRMUcriteria.CMSwillconsiderthisexceptiononacase-by-casebasis.

• Scope of Practice: EPswhodonotseepatientsface-to-faceorwhopracticeinmultiple

locationswheretheyhavenocontrolovertheavailabilityofEHRtechnology.

>The face-to-faceexemption isdirectedtowardsAnesthesiologists,Patholo-

gists,andRadiologistsandtheseEPsmustberegisteredinMedicare’sPro-


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viderEnrollmentChainandOwnershipSystem(PECOS)withaprimaryspe-

cialtyofanesthesiology,pathologyorradiology.

>ThemultiplelocationsexemptioncoversEPswhoseepatientsinmultiplelo-

cationssuchasASCsornursinghomeswheretheEPhasnointerestorsay

inwhetherthefacilitiesinstallcertifiedEHRsystemsfortheiruse.Asthese

facilitiesarenotrequiredunder theEHRProgramstobeEHRcertified, the

EPswouldbeartheentireimpactofanypaymentadjustment.

>TherulingstatesthattheScopeofPracticeexemptionsmaynotbeawarded

formorethan5years.CMSwillregularlyassessmeaningfulusecompliance

levelsandtheoverallstateofhealthinformationexchangeandmaymakereg-

ulatorychangesordevelopnewguidancethatwouldeliminate theneedfor

thisexception.Newlegislationmustbepassedinordertomakethisexemp-

tionpermanent.

Thedeadlinetoapplyfortheexemptionfromthe2015paymentadjustmentisJuly1,2014.How-

ever,CMShasnotyetpublishedtheapplicationprocess.

THE REQUIREMENTS FOR REPORTING MEANINGFUL USE

EHR SYSTEMS MUST BE CERTIFIED FOR CMS REGULATIONS

EPsmustuseEHRsystemsthathavebeencertifiedtomeettheCMSregulationsinordertore-

ceiveincentivemoney.CMShasapproved6organizationstoperformCompleteEHRand/orEHR

Moduletestingandcertification.TheseONC-AuthorizedTestingandCertificationBodies(ATCBs)

arerequiredtotestandcertifyEHRstotheapplicablecertificationcriteriaadoptedbytheSecre-

taryundersubpartCofPart170PartIIandPartIIIasstipulatedintheStandards and Certification Criteria Final RuleThefollowingorganizationshavebeenselectedasONC-(ATCBs):

• Surescripts LLC-Arlington,VA

Dateofauthorization:December23,2010.

Scopeofauthorization:EHRModules:E-Prescribing,PrivacyandSecurity.

• ICSA Labs-Mechanicsburg,PA


Scopeofauthorization:CompleteEHRandEHRModules.

• SLI Global Solutions-Denver,CO



• InfoGard Laboratories, Inc.–SanLuisObispo,CA

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http://healthit.hhs.gov/portal/server.pt?open=512&objID=1195&parentname=CommunityPage&parentid=97&mode=2&in_hi_userid=11673&cached=true

http://www.surescripts.com

https://www.icsalabs.com

http://www.sliglobalsolutions.com

http://www.infogard.com

Dateofauthorization:September24,2010.


•Certification Commission for Health Information Technology (CCHIT)-Chicago,IL



•Drummond Group, Inc. (DGI)-Austin,TX



TheCertified Health IT Product List listsallEHRsystemsthathavebeencertifiedfortheEHR

IncentiveProgram.Thisonlinelistofcertifiedelectronichealthrecordtechnologyisupdatedas

ONC-ATCBscertifynewproducts.

2013 REQUIREMENTS FOR STAGE 1 OF MEANINGFUL USE

1.Thereareatotalof25meaningfuluseobjectives(CoreandMenu-set)forEPs.Theseobjectives

werecreatedtoshowhowwellaproviderisusingEHRbyensuringbasicpatientinformation

iscapturedinthemedicalrecordandenteredintotheEHRsystem.Toqualifyforanincentive

payment,20ofthese25objectivesmustbemet.

2.EPsmustalsoreportonatotalof6quality measures:3requiredcoremeasures(substituting

alternatecoremeasureswherenecessary)and3additionalmeasures.Amaximumof9mea-

sureswouldbereportediftheEPneededtoattesttothe3requiredcore,the3alternatecore

andthe3additionalmeasures

CORE & MENU-SET OBJECTIVES

InordertobeameaningfuluserinStage1,anEPmustreportboththerequired15“coreset”and

5“menuset”objectives(outof10)thatarespecifictoeligibleprofessionals(EPs).TheStage2

RulingmadesomechangestothecurrentStage1objectiveswhichwillbecomeeffective January

1, 2013. Thechangesarelistednexttotheapplicableobjective.

CORE OBJECTIVES - EPS ARE REQUIRED TO REPORT THE FOLLOWING 15 EHR OBJECTIVES

1.ComputerizedProviderorderentry(CPOE)-CMSisaddinganoptionalalternatemeasure.Thecurrentmeasureisbasedonthenumberofuniquepatientswithamedicationintheirmedica-tionlistthatwasenteredusingCPOE.Thenewmeasureisbasedonthetotalnumberofmedi-cationorderscreatedduringtheEHRreportingperiods.

2.Drug-druganddrug-allergyinteractionchecks


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http://www.cchit.org

http://www.drummondgroup.com

http://oncchpl.force.com/ehrcert?q=chpl


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3.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses

4.Electonic-prescribing-CMSisaddinganadditionalexclusionforproviderswhoarenotwithina10mileradiusofapharmacythatacceptselectronicprescriptions.

5.Maintainactivemedicationlist

6.Maintainactivemedicationallergylist

7.Recorddemographics

8.Recordandchartchangesinvitalsigns(optional in 2013) -Thecurrentmeasurespecifiesthatvitalsignsmustberecordedformorethan50percentofalluniquepatientsages2andover.Thenewmeasureamendsthatagelimittorecordingbloodpressureforpatientsages3andoverandheightandweightforpatientsofallages.Theexclusionsarealsochanging.

9.Recordsmokingstatusforpatients13yearsandolder

10.ReportambulatoryclinicalqualitymeasurestoCMS/States-Therewillnolongerbeasepa-rateobjective for reportingambulatoryCQMsaspartofMU. Theobjective is incorporateddirectlyintothedefinitionofameaningfulEHRuser.

11.Implementoneclinicaldecisionsupportrule

12.Providepatientswithanelectroniccopyoftheirhealthinformation,uponrequest

13.Provideclinicalsummariesforpatientsforeachofficevisit

14.Capabilitytoexchangekeyclinicalinformationamongprovidersofcareandpatient-authorized

entitieselectronically-TheobjectivewillnolongerberequiredforStage1.

15.Protectelectronichealthinformation

MENU-SET OBJECTIVES - Providers must choose 5 EHR objectives from the following menu:

1.Drug-formularychecks

2.Incorporateclinicallabtestresultsasstructureddata

3.Generallistsofpatientsbyspecificconditions

4.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare

5.Providepatientswithtimelyelectronicaccesstotheirhealthinformation

6.Use certified EHR technology to identify patient-specific education resources and provide to

patient,ifappropriate

7.Medicarereconciliation

8.Summaryofcarerecordforeachtransitionofcare/referrals

9.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems*

10.Capabilitytoprovideelectronicsyndromicsurveillancedatatopublichealthagencies*

*AlloftheStage1publichealthobjectiveswillrequirethatprovidersperformatleastonetestof

theircertifiedEHRTechnology’scapabilitytosenddatatopublichealthagencies,exceptwhere

prohibited.

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Core and Menu Set ExclusionsIfanEPcannotmeetaspecificMUobjectivebecauseitisoutsidethescopeoftheirpracticethey

maypossiblybeallowedtoexemptthatobjective.Forthe13ofthe25criteriathathaveexclusions,

CMSdesignatesnarrowwindowsforphysicianstoreportthattheobjectiveormeasuredoesnot

applytothembecausetheyhavenopatients,ornoorinsufficientnumberofactionsthatwould

allowcalculationofthemeaningfulusemeasure.Twoexamplesare

•Aphysicianwhohasnopatientsage65orolderorage5oryoungerwouldnothaveto

meettherequirementtosendanappropriatereminderto20percentormoreofallpa-

tientsinthoseagegroupsduringtheEHRreportingperiod.

•AnEPmustwriteatleast100prescriptionstobeeligibleforthee-prescribingobjective.

IfanEPdoesnotwrite100prescriptions,he/shecanbeexemptfromthatobjective.

Notall objectivescanbeexcludedbutifanobjectiveisexempt,itcancountthesameasifthat

objectivewasmet.Intheaforementionedexamples,theEPmaygivetheobjectivea“0”andthen

reportontheremaining19objectives.

Detaileddescriptionsofallthecoreandmenu-setobjectivesincludingthenumerators,denomi-

nators,thresholdsandexclusionscanbefoundatEHRIncentivePrograms.Attestationrequire-

mentsarealsolisted.

CLINICAL QUALITY MEASURES (CQMs)

SimilartoPQRS,aspartofthecriteriaforsatisfyingmeaningfuluse,clinicalqualitymeasures

resultsmustalsobereportedtoCMSinadditiontotheCoreandMenuobjectives..

InordertoreportqualitymeasuresfromanEHR,electronicspecificationsweredevelopedthat

includethedataelements,logic,anddefinitionsforthatmeasureinaformatthatcanbecaptured

orstoredintheEHRsothatthedatacanbesentorsharedelectronicallywithotherentitiesina

structured,standardized,andunalteredformat.

Eachelectronicspecificationcontainsthefollowing4maincomponents

•MeasureOverview/Description–Measuretitle,description,number,measurementpe-

riod,measuresteward,andotherrelevantinformationtothemeasure.

•MeasureLogic–populationcriteriaandmeasurelogicforthenumerator,denominator

andexclusioncategoriesandthealgorithmusedtocalculateperformance

•MeasureCodelists

•QDS(QualityDataSets)Elements–listsanddescribeseachQualityDataSet(QDS)data

elementassociatewiththemeasure.

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http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf


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TheGuide for Reading EP measures andeachmeasureanditscomponentscanbeviewedinthe

downloadsectionofthe Quality Measure Specifications site.Bothofthefollowingtwodocuments

shouldbeviewedtounderstandtheelectronicmeasuresapplicabletoyourpractice.(Thexxxbe-

lowisthemeasurenumber)

1. NQF_HQMF_HumanReadable_xxx.pdf-ThisfilecontainstheeMeasurespecifications

includingmeasurebackgroundinformation,requireddataelements,measurelogicand

measurecalculationinstructions.

2. NQF_Retooled_Measure_xxx.xls–Thisfilecontainsallofthecodelists(asynonymfor

valuesets)referencedbyallQDSdataelementsintheeMeasures.

Reporting Quality MeasuresEPsmustreporton3requiredCoreQualityMeasures(CQMs),andifthedenominatorofoneor

moreoftherequiredcoremeasuresis0,thentheEPsarerequiredtoreportresultsforupto3

alternatecoremeasures(ACMs).

Inaddition,EPsmustalsoselect3additionalCQMsfromasetof38CQMs(excludingthecore/

alternatecoremeasures.)Itisacceptabletohave‘0’denominatorsprovidedtheEPdoesnothave

anapplicablepopulation.

Core Quality Measures-NQF(NationalQualityForum)MeasureNumber&PQRSImplementa-

tionNumber/ClinicalMeasureTitle)

1.NQF0013-HypertensionBloodPressureMeasurement

2.NQF0028–PreventiveCareandScreeningMeasurePair

a.TobaccoUseAsessment

b. TobaccoCessationIntervention

3.NQF0421,PQRS128–AdultWeightScreeningandFollow-up

Alternate Core Quality Measures - (NQFMeasureNumber&PQRS ImplementationNumber/

ClinicalMeasureTitle)

1. NQF0024–WeightAsssessmentandCounselingforChildrenandAdolescents

2.NQF0041–PQRI110–PreventiveCare&Screening;InfluenzaImmunizationforPa-

tients50Yearsoldandolder

3. NQF0038–ChildhoodImmunizationStatus

CLINICAL QUALITY MEASURES – EPS MUST COMPLETE 3 OF THE 38 MEASURES

1.Diabetes:HemoglobinA1cPoorControl

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2.Diabetes:LowDensityLipoprotein(LDL)ManagementandControl

3.Diabetes:BloodPressureManagement

4.HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngiotensinRe-

ceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(LVSD)

5.CoronaryArteryDisease(CAD):Beta-BlockerTherapyforCADPatientswithPriorMyo-

cardialInfarction(MI)

6.PneumoniaVaccinationStatusforOlderAdults

7.BreastCancerScreening

8.ColorectalCancerScreening

9.CoronaryArteryDisease(CAD):OralAntiplateletTherapyPrescribedforPatientswithCAD

10.HeartFailure(HF):Beta-BlockerTherapyforLeftVentricularSystolicDysfunction

11.Anti-depressantmedicationmanagement:

(a)EffectiveAcutePhaseTreatment,

(b)EffectiveContinuationPhaseTreatment

12.PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation

13.DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdemaand

LevelofSeverityofRetinopathy

14.DiabeticRetinopathy:CommunicationwiththePhysicianManagingOngoingDiabetesCare

15.AsthmaPharmacologicTherapy

16.AsthmaAssessment

17.AppropriateTestingforChildrenwithPharyngitis

18.OncologyBreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/Pro-

gesteroneReceptor(ER/PR)PositiveBreastCancer

19.OncologyColonCancer:ChemotherapyforStageIIIColonCancerPatients

20.SmokingandTobaccoUseCessation,MedicalAssistance:

a)AdvisingSmokersandTobaccoUserstoQuit,

b)DiscussingSmokingandTobaccoUseCessationMedications,

c)DiscussingSmokingandTobaccoUseCessationStrategies

21.Diabetes:EyeExam

22.Diabetes:UrineScreening

24.Diabetes:FootExam

25.CoronaryArteryDisease(CAD):DrugTherapyforLoweringLDL-Cholesterol

26.HeartFailure(HF):WarfarinTherapyPatientswithAtriaFibrillation

27.IschemicVascularDisease(IVD):BloodPressureManagement

28.IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic

29.InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment:

a)Initiation,

b)Engagement

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30.PrenatalCare:ScreeningforHumanImmunodeficiencyVirus(HIV)

31.PrenatalCare:Anti-DImmuneGlobulin

32.ControllingHighBloodPressure

33.CervicalCancerScreening

34.ChlamydiaScreeningforWomen

35.UseofAppropriateMedicationsforAsthma

36.LowBackPain:UseofImagingStudies

37.IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl

38.Diabetes:HemoglobinA1cControl(<8.0%)

Clinical Quality Measures ExclusionsIftherequiredcore,alternatecore,orothermeasuresdonotencompassthetypeofpatientsthat

anEPtypicallysees,theEPmayassignazerovalue.CMS’guidancestates:“Aneligibleprofes-

sional(EP)isnotexcludedfromreportingcoreclinicalqualitymeasures.However,zeroisanac-

ceptablevaluetoreportforthedenominatorofaclinicalqualitymeasureifthereisnopatientpop-

ulationwithintheEHRtowhomthatclinicalqualitymeasureapplies.Intheeventthatnoneofthe

44clinicalqualitymeasuresappliestoanEP’spatientpopulation,theEPisstillrequiredtoreport

azeroforthedenominatorsforallsixofthecoreandalternatecoreclinicalqualitymeasures.”..

REGISTRATION & ATTESTATION FOR THE MEDICARE EHR PROGRAM

REGISTRATION

CMSstatesallEPsshouldregisterfortheprogrameveniftheyarenotyetonanEHRsystem.An

EPmustberegisteredinPECOSbeforeregisteringfortheEHRIncentiveProgram.

ToregisterforEHR,thefollowinginformationisneededforeachEP

•NationalProviderIdentifier(NPI).

•NationalPlanandProviderEnumerationSystem(NPPES)UserIDandPassword.

•PayeeTaxIdentificationNumber(ifyouarereassigningyourbenefits).

•PayeeNationalProviderIdentifier(NPI)(ifyouarereassigningyourbenefits).

Ifyouhavenotyetregistered,seetheRegistration User Guide for Medicare Eligible Professionals

forstep-by-stepregistrationinstructions.

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ATTESTATION & eREPORTING

TherearetworeportingmethodsavailableforreportingtheStage1measures;Attestationand

eReportingPilots.

Attestation -EPsmustberegisteredandhavedecidedwhichobjectivesandqualitymeasures

theywillperformbeforecanattestthattheyareusingacertifiedEHRproduct. Attestationre-

quirescompletingtheAttestationandPaymentform.CMSwillallowanEPtodesignateathird

partytoregisterandattestonhisorherbehalf.

ThiswillrequiretheappointedpartytohaveanIdentityandAccessManagementSystem(I&A)

webuseraccount(UserID/Password),andbeassociatedtotheEP’sNationalProviderIdentifier

(NPI).IftheappointedpersondoesnothaveanI&Awebuseraccount,visitthefollowingwebsite

tohaveonecreated.

https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do

CMSoffersthefollowingguidebooksofferingstep-by-stepinstructionstoassistEPstoregister

andattesttotheEHRIncentiveProgram.

Attestation User Guide for Medicare Eligible Professionals

For more information on webinar tutorials, attestation worksheets and calculators, visit CMS’

Registration & Attestation site.

eReporting Pilots–ParticipationintheeReportingPilotisvoluntaryandenablesEPstoreport

EHRMUandPQRSqualitymeasurestogetherandwouldsatisfyrequirementsofboththeMUand

PQRSprograms.ThekeydifferencesbetweenthepilotandreportingMUandPQRSseparately:

•Reportingperiodistheentireyear

•DataissubmittedonMedicareBpatientsonly

•ReportthequalitymeasuresrequiredforMU

ProvidersmustindicatetheirintenttoparticipateviatheMUattestationpage.

Tolearnmoreaboutthisreportingfeatures,clickbelow:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2012PQRS_MedicareEHR-IncentPilot_Final508_1-13-2012.pdf

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https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP_Attestation_User_Guide.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html

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STAGE 2 – JANUARY 1, 2014

Stage1criteriafocusesonelectronicallycapturinghealthinformationinacodedformatandus-

ingthatinformationtotrackkeyclinicalconditionswhilecommunicatingthatinformationforcare

coordinationpurposes.Stage2expandsuponStage1toencouragetheuseofhealthITforcon-

tinuous quality improvement at the point of care and the exchange of information in the most

structuredformatpossible.

Toaccomplishthis,Stage2willstillrequiremeeting20objectives. Theseobjectiveswillmake

mandatorysomeEHRmeasuresthatareoptionalforStage1aswellasupgradeStage1mea-

surestohigherthresholds.

Thenumberofrequiredcoresetmeasuresisincreasedto17from15,withEPsreporting3outof

6additionalmenusetmeasures.

COREOBJECTIVES

•9ofthecurrentStageOne15CoreObjectivesremain

•7ofthe10currentmenuobjectiveswillbecomeCoreobjectives

•1newcoreobjectivewillbeadded

•6ofthecurrentCoreObjectiveswereeitherdeletedorincorporatedintootherobjectives

MENUOBJECTIVES

•1ofthecurrentmenuobjectiveswillremain

•5newobjectiveswillbeadded

Inaddition,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selectingthem

fromatleast3ofthe6keyhealthcarepolicydomains.

Formoreinformation,seethe Stage 1 vs. Stage 2 ComparisonchartofferedbyCMSandseethe

Stage2CoreandMenuObjectivesinAddendum1.

CLINICALQUALITYMEASURES(CQMs)

•In2014,EPsmustreporton9outof64totalclinicalqualitymeasures(CQMs),selecting

themfromatleast3ofthe6keyhealthcarepolicydomains.SeeAddendum2forthe

2014CQMs.

Other Stage 2 Changes • Electronically reporting CQMs-Beginningin2014,allMedicareEPsbeyondtheirfirst

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yearofdemonstratingMUmustelectronicallyreporttheirCQMdatatoCMS.

• Definition Change of Hospital-Based EP–EPswhocandemonstratethattheyfundthe

acquisition,implementation,andmaintenanceofCEHRT(certifiedelectronichealthre-

cordtechnology),includingsupportinghardwareandinterfacesneededformeaningful

usewithoutreimbursementfromaneligiblehospitalorCAH,inlieuofusingthehospi-

tal’sCEHRT,canbedeterminednon-hospital-basedandpotentiallyreceiveanincentive

payment.

• Adoption of 2014 Technology Criteria - All EHR Incentive Programs participants will

havetoadoptcertifiedEHRtechnologythatmeetsONC’sStandards&CertificationCri-

teria2014FinalRule

• Reporting Period Reduced to Three Months–toallowproviderstimetoadopt2014cer-

tifiedEHRtechnologyandprepareforStage2,allparticipantswillhaveathreemonth

reportingperiodin2014.Thiswillonlyoccurin2014.

• Menu Objective Exclusions–WhileEPsmaycontinuetoclaimexclusionsifapplicable

formenuobjectives,startingin2014,theseexclusionswillnolongercounttowardsthe

numberofmenuobjectivesneededifthereareothermenuobjectiveswhichtheycan

select.EPswillnotbepenalizedforselectingamenuobjectiveandclaimingtheexclu-

sioniftheywouldalsoqualityfortheexclusionsforalltheremainingmenuobjectives.

• Batch Reporting-Startingin2014,groupswillbeallowedtosubmitattestationinforma-

tionforalloftheirindividualEPsinonefileforuploadtotheAttestationSystem,rather

thanhavingeachEPindividuallyenterdata.

ADDENDUM 1 - STAGE 2 EHR INCENTIVE PROGRAM

17 CORE OBJECTIVES (EPs must report on all)

Current Core Objectives Remaining in Stage 2 1.ComputerizedProviderOrderEntry(CPOE)(Morethan60%ofmedication,30%oflabs,

30%ofradiology)

2.E-prescribing(morethan50%ofprescriptions)

3.Recordpatientdemographicinformation(>80%uniquepatients(UP))

4.Recordandchartchangesinvitalsigns(>80%UP)

5.Recordsmokingstatusforpatients13yearsorolder(>80%UP)

6.Useclinicaldecisionsupport(5interventions&drug/drug,drug/allergy)

7.PatientElectronicAccesstotheirhealthinformation(>75%UPwith>5%accessing)

8.Provideclinicalsummariesforpatientsforeachofficevisit(>50%ofvisits)

9.Protectelectronichealthinformation

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Current Menu Objectives Upgraded to Core Objectives 10.IncorporateclinicallabtestresultsintoEHR(>55%)

11.Generatelistsofpatientsbyspecificconditions

12.Sendreminderstopatientsperpatientpreferenceforpreventive/followupcare(10%

w/2ormorevisits)

13.UsecertifiedEHRtechnologytoidentifypatient-specificeducationresources(>10%)

14.Medicationreconciliation(>50%)

15.Summaryofcarerecordforeachtransitionofcare/referral

16.Capabilitytosubmitelectronicdatatoimmunizationregistries/systems*

New Objective 17.Use Secure electronic messaging to communicate with patients on relevant health

information(>5%)

6 MENU OBJECTIVES (EPs must report on 3 of these objectives)

Current Menu Objective Remaining in Stage 2 1.Submitelectronicsyndromicsurveillancedatatopublichealthagencies

New Menu Objectives 2.Recordelectronicnotesinpatientrecords(>30%UP)

3.ImagingresultsaccessiblethroughCEHRT(>10%imagingresults)

4.Recordpatientfamilyhealthhistory(>20%UP)

5.IdentifyandreportcancercasestoaStatecancerregistry

6.Identifyandreportspecificcasestoaspecializedregistry(otherthanacancerregistry)

DELETED OBJECTIVES:

Thefollowingcurrentcoreobjectiveswereeitherdeletedorincorporatedintootherobjectives

forStage2.

1.Drug-druganddrug-allergyinteraction(IncorporatedintoCoreObjective#6)

2.Maintainanup-to-dateproblemlistofcurrentandactivediagnoses(Incorporatedinto

Stage2objective#15)

3.Maintainactivemedicationlist(IncorporatedintoCoreObjective#15)

4.Maintainanactivemedicationallergylist(incorporatedintoCoreObjective#15)

5.Report ambulatory clinical quality measures (CQMs) to CMS/States (Removed as an

objectivebutismandatedasageneralpartofEHR)

6.Capability toexchangekeyclinical informationamongprovidersofcareandpatient-

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authorizedentitieselectronically(EliminatedinbothStage1&2)

7.Implementdrug-formularychecks(Menu)–(IncorporatedintoCoreObjective2)

8.Providepatientswithtimelyelectronicaccesstotheirhealthinformationwithin4busi-

nessdaysofinformationbeingavailabletoEP(Menu)(EliminatedfromStage1in2014

andnolongeranobjectiveforStage2)

CLINICAL QUALITY MEASURES (CQMs) FOR 2014

The64final2014qualitymeasuresarelistedinAddendum2.

HEALTH CARE POLICY DOMAINS

Stage2willoffer64clinicalqualitymeasuresofwhichEPsmustreportonatleast9.The9mea-

suresmustbeselectedfromatleast3ofthefollowing6healthcarepolicydomains.

1.PatientandFamilyEngagement

2.PatientSafety

3.CareCoordination

4.PopulationandPublicHealth

5.EfficientUseofHealthcareResources

6.ClinicalProcesses/Effectiveness

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ADDENDUM 2 – 2014 CLINICAL QUALITY MEASURES (CQMs)

Italicizes measures were either available or very similar to the measures introduced in Stage 1. The 4-digit number is the NQF (National Quality Forum) clinical measure number.

Detailed information such as the measure description, numerator and denominator statements, and the measure steward may be found on the CMS website.

1.0002AppropriateTestingforChildrenwithPharyngitis 2.0004InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment 3.0018ControllingHighBloodPressure 4.0022UseofHigh-RiskMedicationsintheElderly

5.0024WeightAssessmentandCounselingforNutritionandPhysicalActivityforChil-

drenandAdolescents

6.0028PreventiveCareandScreening:TobaccoUse:ScreeningandCessationIntervention 7.0031BreastCancerScreening 8.0032CervicalCancerScreening 9.0033ChlamydiaScreeningforWomen 10.0034ColorectalCancerScreening 11.0036UseofAppropriateMedicationsforAsthma 12.0038ChildhoodImmunizationStatus

13.0041PreventiveCareandScreening:InfluenzaImmunization

14.0043PneumoniaVaccinationStatusforOlderAdults 15.0052UseofImagingStudiesforLowBackPain 16.0055Diabetes:EyeExam 17.0056Diabetes:FootExam 18.0059Diabetes:HemoglobinA1cPoorControl 19.0060HemoglobinA1cTestforPediatricPatients

20.0062Diabetes:UrineProteinScreening 21.0064Diabetes:LowDensityLipoprotein(LDL)Management 22.0068IschemicVascularDisease(IVD):UseofAspirinorAnotherAntithrombotic 23.0069AppropriateTreatmentforChildrenwithUpperRespiratoryInfection(URI) 24.0070CoronaryArteryDisease(CAD):Beta-BlockerTherapy—PriorMyocardialInfarc-

tion(MI)orLeftVentricularSystolicDysfunction(LVEF<40%) 25.0075IschemicVascularDisease(IVD):CompleteLipidPanelandLDLControl 26.0081HeartFailure(HF):Angiotensin-ConvertingEnzyme(ACE)InhibitororAngio-

tensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunc-tion(LVSD)

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27.0083HeartFailure(HF):BetaBlockerTherapyforLeftVentricularSystolicDysfunc-tion(LVSD)

28.0086PrimaryOpenAngleGlaucoma(POAG):OpticNerveEvaluation 29.0088DiabeticRetinopathy:DocumentationofPresenceorAbsenceofMacularEdema

andLevelofSeverityofRetinopathy 30.0089Diabetic Retinopathy: Communication with the Physician Managing Ongoing

DiabetesCare 31.0101Falls:ScreeningforFutureFallRisk

32.0104MajorDepressiveDisorder(MDD):SuicideRiskAssessment

33.0105Anti-depressantMedicationManagement 34.0108ADHD:Follow-UpCare forChildrenPrescribedAttentionDeficit/Hyperactivity

Disorder(ADHD)Medication

35.0110BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsub-

stanceuse

36.0384Oncology:MedicalandRadiation–PainIntensityQuantified

37.0385ColonCancer:ChemotherapyforAJCCStageIIIColonCancerPatients 38.0387BreastCancer:HormonalTherapyforStageIC-IIICEstrogenReceptor/Pro-

gesteroneReceptor(ER/PR)PositiveBreastCancer 39.0389ProstateCancer:AvoidanceofOveruseofBoneScanforStagingLowRiskPros-

tateCancerPatients

40.0403HIV/AIDS:MedicalVisit

41.0405HIV/AIDS:Pneumocystisjirovecipneumonia(PCP)Prophylaxis

42.0418PreventiveCareandScreening:ScreeningforClinicalDepressionandFollow-UpPlan

43.0419DocumentationofCurrentMedicationsintheMedicalRecord

44.0421PreventiveCareandScreening:BodyMassIndex(BMI)ScreeningandFollow-Up

45.0564Cataracts:Complicationswithin30DaysFollowingCataractSurgeryRequiring

AdditionalSurgicalProcedures

46.0565Cataracts:20/40orBetterVisualAcuitywithin90DaysFollowingCataractSurgery

47.0608PregnantwomenthathadHBsAgtesting

48.0710DepressionRemissionatTwelveMonths

49.0712DepressionUtilizationofthePHQ-9Tool

50.TBDChildrenwhohavedentaldecayorcavities

51.1365ChildandAdolescentMajorDepressiveDisorder:SuicideRiskAssessment

52.1401Maternaldepressionscreening

53.1401Maternaldepressionscreening

54.TBDPrimaryCariesPreventionInterventionasOfferedbyPrimaryCareProviders,

includingDentists

55.TBDPreventiveCareandScreening:Cholesterol–FastingLowDensityLipoprotein

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(LDL-C)TestPerformed

56.TBDPreventiveCareandScreening:Risk-StratifiedCholesterol–FastingLowDen-

sityLipoprotein(LDL-C)

57.TBDDementia:CognitiveAssessment

58.TBDHypertension:Improvementinbloodpressure

59.TBDClosingthereferralloop:receiptofspecialistreport

60.TBDFunctionalstatusassessmentforkneereplacement

61.TBDFunctionalstatusassessmentforhipreplacement

62.TBDFunctionalstatusassessmentforcomplexchronicconditions

63.TBDADEPreventionandMonitoring:WarfarinTimeinTherapeuticRange

64.TBDPreventiveCareandScreening:ScreeningforHighBloodPressureandFollow-

UpDocumented

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