Advancing Care Information: What's New in MIPS 2018?

As the submissions for 2017 performance year wrap up, it’s perfect time to get started with 2018. In our previous blogs, we discussed the Quality and Cost categories. In this post, we focus our attention on the Advancing Care Information (ACI) category and the noteworthy changes for performance year 2018.  

 3 noteworthy changes in the  Advancing Care Information (ACI)  category for  MIPS 2018 .  

 

Additional Bonus Option

There are two ACI measure sets available for the eligible clinicians and groups to choose from. Both measure sets offer the same earning potential for the “Base” and “Performance” measures as points are adjusted accordingly. However, there is a slight advantage to using 2015 edition EHR exclusively and earn 10 more bonus points.

    Advancing Care Information Objectives and Measures

    2015 edition EHR, or a combination of 2014 and 2015 EHR editions is required to choose this option.

    Base Measures – 5 measures (max 50 points)

    Performance Measures – 9 measures (max 90 points)

    Bonus Potential – 25 points

    (An additional 10 bonus points for using 2015 edition certified EHR exclusively)

    2018 Advancing Care Information Transition Objectives and Measures

    This is the only option if for reporting using a 2014 edition EHR.                                                    

    Base Measures – 4 measures (max 50 points)

    Performance Measures - 7 measures (max 90 points)

    Bonus Potential - 15 points

     

     

    If you are considering upgrading to 2015 certified version of your EHR, now would be a good time to do so as only 90 consecutive days of ACI data is required. The use of 2014 EMR has been extended to 2018, but it might not be an option in the reporting year 2019.

     

    Additional Registry Reporting Options 

    Providers can report to a registry to earn 10 performance points in 2018 just like last year. But unlike 2017 when reporting to Immunization Registry was the only registry reporting option to earn performance points, in 2018 providers have multiple registries to pick from. Depending on the measure set, providers can choose to report to any one of the following registries to earn 10 performance points:

    2018 Advancing Care Information Transition Objectives and Measures

    • Immunization Registry Reporting
    • Syndromic Surveillance Reporting
    • Specialized Registry Reporting

    Advancing Care Information Objectives and Measures

    • Immunization Registry Reporting
    • Syndromic Surveillance Reporting
    • Electronic Case Reporting
    • Public Health Registry Reporting
    • Clinical Data Registry Reporting

    Providers can report to an additional registry (not reported under the performance score) and earn 5  bonus points. In other words, a provider cannot earn points under both the performance score and bonus score for reporting to the same registry.

     

    Exclusions and Exceptions Clarified

    MACRA 2018 Final Rule explains more clearly the exclusions and exceptions available to MIPS eligible clinicians. Both provide distinct flexibilities to providers under specific conditions and thus it’s important to understand the difference between the two.

    1.      EXCLUSIONS 

    Exclusions are available to all the eligible clinicians who report data for the ACI category if they meet certain criteria defined for certain base measures. For instance, exclusion can be claimed for the E-Prescribing measure, by a MIPS eligible clinician who writes fewer than 100 permissible prescriptions during the performance period. Claiming the exclusion allows the eligible clinicians to complete the ACI Base Requirements and earn an ACI score. 

    Claiming an exclusion does NOT reweight the ACI category to 0%. 

    Exclusions are available for E-Prescribing, Health Information Exchange (Send a Summary of Care, Request/Accept Summary of Care). However, exclusion CANNOT be claimed for Security Risk Analysis and Provide Patient Access measures. They have to be completed in order to complete base requirements and earn an ACI score.

    2.      EXCEPTIONS 

    CMS will reweight the ACI category to 0% and reassign its weight (25%) to the Quality performance category (making it 75%) in certain situations as per the provisions in the 21st Century Cures Act and MACRA. Reweighting can either be automatic or requested by filing an application.

    a. Automatic Reweighting: The ACI category will automatically be reweighted to 0% without submitting any application for:

    • Hospital-based MIPS eligible clinicians
    • Non-Patient-Facing clinicians or groups with >75% NPF clinicians
    • Ambulatory Surgical Center (ASC) based MIPS eligible clinicians
    • MIPS eligible Physician Assistants, Nurse Practitioners, Clinical Nurse Specialist, and Certified Registered Nurse Anesthetists

    b. Reweighting by Hardship Exception Application: Eligible clinicians facing insurmountable challenges in the way of using an EHR can submit an application by Dec 31, 2018 to claim the hardship exception and get the ACI category reweighted to 0%.

    • Clinicians in a Small Practice (1-15 eligible clinicians) facing overwhelming barriers to adopting a certified EHR (new hardship exception introduced in 2018)
    • Clinicians whose EHR got decertified during the 2018 performance year 
    • Clinicians who have insufficient internet connectivity
    • Clinicians facing extreme and uncontrollable circumstances caused by natural disasters
    • Clinicians who don’t have control over availability of Certified EHR technology

    [Read a complete overview of Advancing Care Information Category for 2018]

    The 2018 version of MyMipsScore guides you through each measure set for the Advancing Care Information performance category and all the related options to help you analyze and maximize your performance in each performance category.

    Learn how you can get MyMipsScore for your organization.



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