MIPS Dashboard

For the 2019 performance year, CMS has expanded the types of eligible clinicians to include:

• Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, optometry, osteopathic practitioners and chiropractors)
• Physician Assistants
• Nurse Practitioners
• Clinical Nurse Specialists
• Certified Registered Nurse Anesthetists
• Clinical Psychologists (Newly added for 2019)
• Physical Therapists (Newly added for 2019)
• Occupational Therapists (Newly added for 2019)
• Qualified Speech-Language Pathologists (Newly added for 2019)
• Qualified Audiologists (Newly added for 2019)
• Registered Dietitians or Nutritional Professionals (Newly added for 2019)

Follow these Steps to Verify Your Eligible Clinician Participation Status:

1. Navigate to the Setup Portal.
   
   


2. Select Providers under Basic Setup.
   
   


3. Search for each billing NPI at the Practice under the Provider Search.
   
   


4. Select the Click here to view MIPS status link.
   
   


5. This will open the CMS QPP Participation Status for the Selected Clinician. Document whether the clinician is eligible as an individual and/or group provider.
6. Go back to step 3 and repeat for all clinicians at the practice.

For more information about MIPS Eligibility, Participation and Scoring, check out the 2019 MIPS 101 Guide and other resources at the QPP Resource Library.

Practices with more than 1 eligible clinician will need to determine whether they wish to report as individuals or as a group.

• An individual clinician submits measures and activities for the practice(s) (identified by TIN) in which the clinician is MIPS eligible.
• A group is defined as a TIN with 2 or more eligible clinicians, including at least 1 MIPS eligible clinician, as identified by their NPIs who have reassigned their Medicare billing rights to the TIN.
• Most practices with 2 or more eligible clinicians will report as a group in order to earn incentives for and to protect the TIN against negative payment adjustments.
• Learn more about the Quality Payment Program in CMS’s Merit-Based Incentive Payment System 101 Guide 2019 Performance Year.

In order to calculate and extract MIPS Quality and Promoting Interoperability data, practices need to setup each MIPS eligible clinician on the MIPS dashboard following these steps:

1. Navigate to the Reports Portal.
   
   
    
2. Select MIPS Dashboard under the Meaningful Use section.
   
   
    
3. Click on the New button to add a new provider.
   
   
    
4. Setup the provider reporting period using the Edit Provider screen.
   
   
    
5. Press the Save button.
6. Repeat the process for all MIPS Eligible Clinicians.

Follow these steps to edit a provider setup on the MIPS Dashboard:

1. Select the Clinician in the list of Providers on the left.
   
   
    
2. Click on the Edit button.
   
   


3. Edit the Clinician as necessary and press the Save button.
   
   

Follow these steps to remove a clinician from the MIPS Dashboard:

1. Select the Clinician in the list of Providers on the left.
   
   


2. Click on the X icon to delete the Clinician.
   
   

For the 2019 MIPS reporting period, the Quality performance category is worth 45% of the Clinician's/Group's final score. Participants are required to collect quality measure data for the 12-month performance period (January 1-December 31, 2019). 

iSalus Healthcare has partnered with with 2 companies for MIPS Quality Reporting in 2019. Those partners are Mingle Health and Dynamic Health IT.

• Mingle Health is an industry-leading Medicare Qualified Clinical Data Registry. They offer robust quality reporting options for our practices and complete MIPS (Promoting Interoperability, Improvement Activity and Quality) reporting to CMS.
• iSalus has also integrated with Dynamic Health IT's CQMsolution as our Electronic Clinical Quality Measure (eCQMs) quality reporting tool. We currently support the following eCQMs through our integration with CQMsolution:
  • CMS22v7 - Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented
  • CMS68v8 - Documentation of Current Medications in the Medical Record
  • CMS69v7 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan
  • CMS122v7 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
  • CMS127v7 - Preventive Care and Screening: Pneumococcal Vaccination Status for Older Adults
  • CMS138v7 - Preventive Care and Screening: Tobacco Use Screening and Cessation Intervention
  • CMS147v8 - Preventive Care and Screening: Influenza Immunization
  • CMS156v7 - Use of High-Risk Medications in the Elderly
  • CMS165v7 - Controlling High Blood Pressure

Most eligible MIPS clinicians will partner with Mingle Health as registries have access to hundreds of quality measures for practices to report on vs. the 9 available eCQMs currently supported by iSalus. To sign-up for Mingle Health, purchase a MIPS Solutions package for each reporting clinician here. Be sure to utilize the ISALUS19MIPS coupon code to receive our discounted rate of $559/Clinician. 

For more information on reporting your 2019 Quality data using our CQMsolution eCQMs, contact our support staff at support@isalushealthcare.com. Learn more about the Quality Performance Category on the qpp.cms.gov website.

iSalus Healthcare offers 4 different quality data extract files which are exported and uploaded into the Mingle Health site to calculate practice MIPS Quality reports. They are as follows:

MIPS Quality PM File Contents

All practices must extract and provide this file to Mingle Health for quality measure calculation. It includes:

• Claim information for patients seen for the NPI and TIN during 01/01/Reporting Year – 12/31/Reporting Year

MIPS Quality Interventions File Contents

Practices tracking quality data with clinical data will need to extract this file if their quality measures include the following clinical data:

• Immunizations setup with a CVX Code
• Patient Education Materials selected in the Patient Education chart tab
• Procedure type Orders
• Referral type Orders
• Lab, Radiology and Pathology type Orders
• Template items setup as CCDA Care Plan Goals or Care Plan Instructions

MIPS Quality Medications File Contents

Practices tracking quality data with clinical data will need to extract this file if their quality measures include the following clinical data:

• Medications for patients seen during the reporting period
• Medications Documented Indicator (Medications Marked as Reviewed on the Patient Timeline Summary)

MIPS Quality Observations File Contents

Practices tracking quality data with clinical data will need to extract this file if their quality measures include the following clinical data:

• Vitals including BMI, Diastolic BP, Systolic BP, Height, Weight, Pain Scale, Heart Rate
• Order Results
• Problems where the status is not Removed
• Allergies
• Smoking Status – Pulls a Specific Global Entity from the Patient History template

Practices who have engaged with our Clinical Data Registry Mingle Health for their quality reporting will need to properly setup and extract data files from the MIPS Dashboard to upload into the Mingle Health portal. The MIPS Dashboard has 4 file extracts that are used for quality reporting depending upon how a practice is tracking their quality measures. Click here to learn more about the specific contents of the Quality Data Extract files. 

Follow these steps to setup the Practice's Mingle Client ID and the time frame in which to pull the MIPS quality data extract files:

1. Click on the Gear button.
   
   


2. Enter the practice Mingle Client ID and setup the appropriate time frame to pull clinical data for the clinical Interventions, Medications and Observations.
   
   


3. Press the Save button to save the settings.

When practices are ready to obtain an updated quality report from Mingle Health, they will need to extract the quality data files to upload in the Mingle Health portal. 

Follow these steps to extract the MIPS Quality Data files:

1. Click on the Individual Clinician or Group to extract files for.
   
   


2. Click on the Quality download menu.
   
   


3. Select All Providers.
   
   


4. Click on the Download Cloud button for all of the files necessary to calculate your practice’s quality measures.These will download to your C drive – iSalusExport folder on your computer’s hard drive.
   
   


5. Login to the Mingle Health Portal.
   
   


6. Select the Modules menu.
   
   


7. Click on the File Upload menu option.
   
   


8. Set the File Type to Practice Management Data (for the PM file) or Clinical Data Extract (for the Medications, Observations and Interventions files).
   
   


9. Set the File Subtype to Year to Date Data.
   
   


10. Select the or click here button to upload your file. It will be in the C:iSalus Export folder.
    
    


11. Enter the File Description as "Practice Name PM/Medication/Observations/Interventions File".
    
    


12. Press the Upload File & Data button. Repeat until all files have been uploaded to Mingle Health.
    
    

For the 2019 MIPS reporting period, the Improvement Activites performance category is worth 15% of the Clinician's/Group's final score. Participants must submit one of the following combinations of activities (each activity must be performed for 90 continuous days or more during 2019):

• 2 high-weighted activities
• 1 high-weighted activity and 2 medium-weighted activities
• 4 medium-weighted activities

High-weighted activities receive 20 points and medium-weighted activities receive 10 points.

You’ll receive double points for each high- or medium-weighted activity you submit if you are an individual clinician, group or virtual group who holds a special status (e.g. small or rural practice).

Clinicians can review the list of possible improvement activities within the Improvement Activities section of the MIPS Dashboard.

You can also learn more about MIPS Improvement Activities at the QPP website. 

For the 2019 MIPS reporting period, the Promoting Interoperability performance category is worth 25% of the Clinician's/Group's final score. Participants will submit a single set of Promoting Interoperability Objectives and Measures to align with 2015 Edition CEHRT.

Starting with the 2019 Performance Year, 2015 Edition CEHRT is required for participation in this category. iSalus' Certification ID is 0015E98CBC4YPD6.

Participants must submit collected data for certain measures for 90 continuous days or more during 2019. Promoting Interoperability reporting periods for 2019 in the MIPS Dashboard can start as soon as 08/11/2019. The following measures and activities for 2019:

• Security Risk Analysis: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by CEHRT in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
• e-Prescribing: At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT. Score Weight: Up to 10%
• Provide Patients Electronic Access to their Health Information: For at least one unique patient seen by the MIPS eligible clinician: (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 eligible clinician 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 eligible clinician's certified electronic health record technology (CEHRT). Score Weight: Up to 40%
• Support Electronic Referral Loops by Sending Health Information: For at least one transition of care or referral to a provider of care other than a MIPS eligible clinician, the MIPS eligible clinician creates a summary of care record using CEHRT; and electronically exchanges the summary of care record. Score Weight: Up to 20%
• Support Electronic Referral Loops by Receiving and Incorporating Health Information: For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician conducts clinical information reconciliation for medication, medication allergy, and current problem list. Score Weight: Up to 20%
• Electronic Case Reporting for Multiple Registry Engagement: Report as true if, active engagement with more than one Electronic Case Reporting registry in accordance with PI_PHCDRR_3. Score Weight: Up to 10%

Bonus Measures for the 2019 Reporting Period: 

• Query of the Prescription Drug Monitoring Program (PDMP): For at least one Schedule II opioid electronically prescribed using CEHRT during the performance period, the MIPS eligible clinician uses data from CEHRT to conduct a query of a Prescription Drug Monitoring Program (PDMP) for prescription drug history, except where prohibited and in accordance with applicable law. Score Weight: Up to 5%
• Verify Opioid Treatment Agreement: For at least one unique patient for whom a Schedule II opioid was electronically prescribed by the MIPS eligible clinician using CEHRT during the performance period, if the total duration of the patient's Schedule II opioid prescriptions is at least 30 cumulative days within a 6-month look-back period, the MIPS eligible clinician seeks to identify the existence of a signed opioid treatment agreement and incorporates it into the patient's electronic health record using CEHRT. Score Weight: Up to 5%

Learn more about the Promoting Interoperability performance category at the qpp resource center. 

Follow these steps to view a clinician or group's MIPS Promoting Interoperability score:

1. Select either the Group or Individual Clinician to see the Promoting Interoperability scores for.
   
   


2. Click on the Hammer button under the Promoting Interoperability section of the Dashboard to calculate/refresh the Promoting Interoperability score for the Group/Individual Clinician.
   
   


3. Click on the Measure name for more information about the measure.
   
   


4. Click Measure Results link to see patient level Measure Results.
   
   


5. View the Patient Measure Results.
   
   

The goal is for the Group/Eligible Clinician’s Promoting Interoperability score to be as close to 25 / 25 as possible

Measures with a * after them are required to have a score > 0 for the promoting interoperability performance category. These measures include:

• Security Risk Analysis
• e-Prescribing
• Provide Electronic Access
• Referral Loops – Send Health Information
• Referral Loops – Receive & Incorporate Health Information
• Public Health and Clinical Data Exchange

The following measures are available as bonus measures for Eligible Clinician's to add an additional 5% points their Promoting Interoperability score: 

• Query of the Prescription Drug Monitoring Program
• Verify Opioid Treatment Agreement

The following measures have been removed for the MIPS 2019 requirements and remain on the dashboard per ONC Certification 2015 Edition requirements:

• Patient Education
• View, Download, Transmit
• Secure Messaging
• Patient Generated Health Data

MIPS Eligible Clinicians must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies.

• Analysis must be conducted when 2015 Edition CEHRT is implemented and during the reporting period year (August 11, 2019 – 12/31/2019 for iSalus Practices)
• The Office of the National Coordinator for Health Information Technology (ONC) has developed a downloadable Security Risk Assessment (SRA) tool to help guide practices through the process. Access the SRA tool here.
• Select the Attest to completing a Security Risk Assessment for my Office checkbox upon completion for each Clinician
  
  

• At least 1 permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.
• This measure is worth up to 10 points towards the clinician’s/group’s Promoting Interoperability score
• The practice must have the Company Setting Use RX HUB on for the duration of the reporting period.
• All printed/electronic prescriptions are in the denominator for the clinician.
• Electronic prescriptions written by the clinician make up the numerator, including Electronic Prescriptions for Controlled Substances.
  
  

• For at least one Schedule II opioid electronically prescribed using CEHRT during the performance period, the MIPS eligible clinician uses data from CEHRT to conduct a query of a PDMP for prescription drug history, except where prohibited and in accordance with applicable law. 
• Eligible clinicians will Attest Yes or Attest No to meeting this measure.
• This measure is worth up to 5 bonus points towards the clinician’s/group’s Promoting Interoperability score.

iSalus has integrated with the Appriss Health PDMP Interface; to see if the interface is available in your state and to obtain a user name and password, fill out the following form from Appriss Health here.

• For at least one unique patient for whom a Schedule II opioid was electronically prescribed by the MIPS eligible clinician using CEHRT during the performance period, if the total duration of the patient’s Schedule II opioid prescriptions is at least 30 cumulative days within a 6-month look-back period, the MIPS eligible clinician seeks to identify the existence of a signed opioid treatment agreement and incorporates it into the patient’s electronic health record using CEHRT. 
• Numerator: The number of unique patients in the denominator for whom the MIPS eligible clinician seeks to identify a signed opioid treatment agreement and, if identified, incorporates the agreement in CEHRT. A numerator of at least one is required to fulfill this measure. 
• Denominator:  Number of unique patients for whom a Schedule II opioid was electronically prescribed by the MIPS eligible clinician using CEHRT during the performance period and the total duration of Schedule II opioid prescriptions is at least 30 cumulative days as identified in the patient’s medication history request and response transactions during a 6-month look-back period. 
• iSalus Healthcare is not supporting the automated calculation of this measure as it is slated for removal beginning with the 2020 performance year.
• This measure is worth up to 5 bonus points towards the clinician’s/group’s Promoting Interoperability score.

• For at least one unique patient seen by the MIPS eligible clinician:
  • The patient (or the patient-authorized representative) is provided timely (within 4 business days of their appointment start time) access to view online, download, and transmit his or her health information; and
  • The MIPS eligible clinician 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 Programming Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT).
• This measure is worth up to 40 points towards the clinician’s/group’s Promoting Interoperability score

Option 1: Connect Patient with a MyMedicalLocker Account

• From the iScheduler, open the patient or select the Patient's Appointment on the schedule.
  
  


• Click on the Patient Index Card Menu and select the MyMedicalLocker Admin option.
  
  


• Click on the Connect Patient button.
  
  


• Enter the Requested by (the patient or a patient authorized representative's name); either their Email Address or Phone Number and press the Email Token button. The patient will be emailed/texted a Token.
  
  
• Ask the patient/rep for the Token that was emailed or texted to them and enter that in the Connect Patient screen.
  
  


• Press the Connect Patient button.
  
  

Option 2: Print a Welcome to MyMedicalLocker Letter at Patient Check-out

• In the iScheduler, right-click over the patient’s appointment and change the appointment status to Check-Out.
  
  


• Click on the Print Queue tab within the Quick Pay screen. If the patient does not already have a MyMedicalLocker connection, a MyMedicalLocker Welcome Letter will display in the print queue.
  
  


• Press the Print button and provide the MyMedicalLocker Welcome Letter to the patient
  
  

• For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider:
  • Creates a summary of care record using certified electronic health record technology (CEHRT); and
  • Electronically exchanges the summary of care record.
• This measure is worth up to 20 points towards the clinician’s/group’s Promoting Interoperability score
• The denominator for this measure is made up of Referral Type Orders placed for the eligible clinician during the reporting period.
  
  


• The numerator is made up of the patient orders from the denominator where a CCDA Referral Note was sent using DIRECT email to the physician receiving the referral.

To send a referral note using DIRECT follow these steps:

1. Open Task Communication.
   
   


2. Click on the New menu.
   
   


3. Select DIRECT Message.
   
   


4. Select the user to send the message to, enter a subject and message.
   
   


5. Click on the Attach button.
   
   


6. Search for the patient.
   
   


7. Select the Transition of Care option. Set the Requested date to the Referral Order Date. Enter a Reason for the Referral.
   
   


8. Press the Attach button.
   
   


9. Press the Send button
   
   

To check receipt of a DIRECT message, follow these steps:

1. Open My Task Communication.
   
   


2. Click on the Sent Items queue.
   
   


3. Find your DIRECT message in the Sent Items Queue. Right-click over the message and select DIRECT Status.
   
   


4. The status must be either 'Accepted' or 'Confirmed' to count towards the numerator of the Referral Loops - Send Health Information MIPS measure.
   
   

• For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician conducts clinical information reconciliation for medication, medication allergy, and current problem list.
• The denominator for this measure is made up of new patient encounters during the performance period where a CCDA was attached to the patient's record for the encounter. 
• The numerator is made up of the patient encounters in the denominator where problem list, medication and allergy reconciliation was performed for the encounter during the reporting period. 
• This measure is worth up to 20 points towards the clinician’s/group’s Promoting Interoperability score
• Exclusions:
  • Any MIPS eligible clinician who is unable to implement the measure for a MIPS performance period in 2019 would be excluded from having to report this measure.  Or 
  • Any MIPS eligible clinician who receives fewer than 100 transitions of care or referrals or has fewer than 100 encounters with patients never before encountered during the performance period. 
• If an exclusion is claimed for this measure, the 20 points will be redistributed to the other measure within this objective, the Support Electronic Referral Loops by Sending Health Information measure. 

Option 1: Import and Attach CCDA Received from Outside Sources

1. Click on the Reports portal.
   
   


2. Click on the Summary of Care option under the EHR section.
   
   


3. Click on the Import button.
   
   


4. Navigate to the location of the Summary of Care XML file on your computer, select it and press the Open button.
   
   


5. The summary of Care displays. The report will display patients whose demographic data match the data within the CCDA. If the correct patient does not display, click on the Search button to either search for or create a new patient. Click on the correct patient’s name and then on the Attach button to incorporate the summary into the patient’s chart.
   
   


6. Summaries must be associated with the patient's new patient encounter to count towards the measure, select the appropriate patient Appointment to link the referral summary to.
   
   


7. If the incorporation is successful, you will receive an alert the attachment was successful.
   
   


8. The summary is now ready for clinical reconciliation. Incorporated summaries will display in the EHR on the Timeline Summary Screen under the Health Exchange section.
   
   


9. Click on the clinical marker to view the summary. 
   
   

Option 2: Receive and Incorporate CCDA Received via DIRECT Message

1. Open My Task Communication
   
   


2. Incoming DIRECT messages display in the user’s Inbox, click on the Message to open it.
   
   


3. CCDA documents will display as an XML attachment. Click on the .xml Attachment to view the summary.
   
   


4. The Report will display patient’s whose demographic data meet the data within the CCDA. If the correct patient does not display, click on the Search button to either search for or create a new patient. Click on the correct patient’s name and then on the Attach button to incorporate the summary into the patient’s chart.
   
   


5. Summaries need associated with a patient encounter to count towards the EP’s MU measure, select the appropriate patient Appointment to link the referral summary to.
   
   


6. If the incorporation is successful, you will receive an alert the attachment was successful.
   
   


7. Incorporated summaries will display in the EHR on the Timeline Summary Screen under the Health Exchange section. 

• The Clinician must attest Yes or Claim an Exclusion to 2 of the 5 Public Health and Clinical Data Exchange reporting options to qualify for this measure.
• This measure is worth up to 10 points towards the clinician’s/group’s Promoting Interoperability score
• The following public health and clinical data exchange options exist:
  • The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS). See Immunization Reporting
  • The MIPS eligible clinician is in active engagement with a public health agency to submit syndromic surveillance data from a non-urgent care setting. See Syndromic Surveillance Reporting
  • The MIPS eligible clinician is in active engagement to submit data to a clinical data registry.
  • The MIPS eligible clinician is in active engagement with a public health agency to electronically submit case reporting of reportable conditions.
  • The MIPS eligible clinician is in active engagement with a public health agency to submit data to public health registries.

Please be sure to familiarize yourself with the following resources for complete information on the QPP MIPS Payment Program:

• Official CMS Quality Payment Program Website
• QPP Participation Status Lookup
• QPP Resource Library (Includes Scoring Guides, User Guides, Webinar Slide Decks and more)
• 2019 MIPS 101 Guide
• 2019 MIPS Scoring Guide