2018 CMS Web Interface

Transcription

1 CMS Web Interface CARE-1 (NQF 0097): Medicatin Recnciliatin Pst- Discharge Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 20 11/13/2017

2 Cntents INTRODUCTION...3 CMS WEB INTERFACE SAMPLING INFORMATION...4 BENEFICIARY SAMPLING... 4 NARRATIVE MEASURE SPECIFICATION...5 DESCRIPTION:... 5 IMPROVEMENT NOTATION:... 5 INITIAL POPULATION:... 5 DENOMINATOR:... 5 DENOMINATOR EXCLUSIONS:... 5 DENOMINATOR EXCEPTIONS:... 5 NUMERATOR:... 5 NUMERATOR EXCLUSIONS:... 5 DEFINITION:... 5 GUIDANCE:... 5 SUBMISSION GUIDANCE...6 PATIENT CONFIRMATION... 6 SUBMISSION GUIDANCE...7 DENOMINATOR CONFIRMATION... 7 SUBMISSION GUIDANCE...8 DENOMINATOR REPORTING... 8 SUBMISSION GUIDANCE...9 NUMERATOR REPORTING... 9 DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT CMS Web Interface V2.0 Page 2 f 20 11/13/2017

3 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The Measure Dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each Measure Dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. CMS Web Interface V2.0 Page 3 f 20 11/13/2017

4 CMS WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the CMS Web Interface Sampling Dcument, which will be made available during the perfrmance year at CMS.gv. CMS Web Interface V2.0 Page 4 f 20 11/13/2017

5 NARRATIVE MEASURE SPECIFICATION THIS MEASURE DOES NOT HAVE A CORRESPONDING ecqm DESCRIPTION: The percentage f discharges frm any inpatient facility (e.g. hspital, skilled nursing facility, r rehabilitatin facility) fr patients 18 years f age and lder seen within 30 days fllwing discharge in the ffice by the physician, prescribing practitiner, registered nurse, r clinical pharmacist prviding n-ging care fr whm the discharge medicatin list was recnciled with the current medicatin list in the utpatient medical recrd IMPROVEMENT NOTATION: N Crrespnding ecqm INITIAL POPULATION: N Crrespnding ecqm DENOMINATOR: All discharges frm any inpatient facility (e.g., hspital, skilled nursing facility, r rehabilitatin facility) fr patients 18 years f age and lder seen within 30 days fllwing discharge in the ffice by the physician, prescribing practitiner, registered nurse, r clinical pharmacist prviding n-ging care DENOMINATOR EXCLUSIONS: Nt Available DENOMINATOR EXCEPTIONS: Nt Available NUMERATOR: Medicatin recnciliatin cnducted by a prescribing practitiner, clinical pharmacist r registered nurse n r within 30 days f discharge NUMERATOR EXCLUSIONS: Nt Available DEFINITION: Medicatin Recnciliatin A type f review in which the discharge medicatins are recnciled with the mst recent medicatin list in the utpatient medical recrd. Dcumentatin in the utpatient medical recrd must include evidence f medicatin recnciliatin and the date n which it was perfrmed. Any f the fllwing evidence meets criteria: (1) Dcumentatin f the current medicatins with a ntatin that references the discharge medicatins (e.g., n changes in meds since discharge, same meds at discharge, discntinue all discharge meds), (2) Dcumentatin f the patient s current medicatins with a ntatin that the discharge medicatins were reviewed, (3) Dcumentatin that the prvider recnciled the current and discharge meds, (4) Dcumentatin f a current medicatin list, a discharge medicatin list and ntatin that the apprpriate practitiner type reviewed bth lists n the same date f service, (5) Ntatin that n medicatins were prescribed r rdered upn discharge; (6) Dcumentatin that patient was seen fr pst-discharge fllw-up with evidence f medicatin recnciliatin r review, (7) Dcumentatin in the discharge summary that the discharge medicatins were recnciled with the current medicatins; the discharge summary must be in the utpatient chart. GUIDANCE: This denminatr is based n discharges fllwed by an ffice visit, nt patients. Patients may appear in the denminatr mre than nce if there was mre than ne discharge fllwed by an ffice visit in the perfrmance perid. CMS Web Interface V2.0 Page 5 f 20 11/13/2017

6 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr reprting requires the fllwing: Guidance Determine if the patient s medical recrd can be fund OR OR If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The CMS Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have been sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) CMS Web Interface V2.0 Page 6 f 20 11/13/2017

7 DENOMINATOR CONFIRMATION Guidance SUBMISSION GUIDANCE Determine if the patient is qualified fr the measure OR If the patient is qualified fr the measure select Yes If there is an ther CMS apprved reasn fr patient disqualificatin frm the measure select N - Other CMS Apprved Reasn Denminatr CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure, and reasn fr request in a CMS Quality Payment Prgram Service inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm a CMS Apprved Reasn is selected will be skipped and anther patient must be reprted in their place, if available. By selecting "N - Other CMS Apprved Reasn", the patient is nly remved frm the measure fr which the reasn was requested, nt all CMS Web Interface measures. CMS Web Interface V2.0 Page 7 f 20 11/13/2017

8 DENOMINATOR SUBMISSION SUBMISSION GUIDANCE Determine if the patient was discharged frm an inpatient facility during the measurement perid OR If the patient was nt discharged frm an inpatient facility n this date select N If the patient was discharged frm an inpatient facility n this date select Yes IF YES Determine if the patient was seen within 30 days fllwing an inpatient facility discharge If the patient was nt seen within 30 days fllwing an inpatient facility discharge select N OR If the patient was seen within 30 days f an inpatient facility discharge select Yes Encunter cdes can be fund in the CMS Web Interface CARE Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr NOTE: - Synnyms fr inpatient facility include: Acute care hspital discharges, psychiatric inpatient discharges, skilled nursing facility discharges r rehabilitatin inpatient discharges - Inpatient discharges will be pre-ppulated frm claims - This measure is t be reprted each time a patient was discharged frm any inpatient facility and had an ffice visit within 30 days f discharge during the measurement perid - Yes" shuld be selected if the discharge date dcumented is within tw calendar days befre r tw calendar days after the prefilled discharge date CMS Web Interface V2.0 Page 8 f 20 11/13/2017

9 NUMERATOR SUBMISSION SUBMISSION GUIDANCE Determine if discharge medicatins were recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge OR If the discharge medicatins were nt recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge select N If the discharge medicatins were recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge select Yes Numeratr cdes can be fund in the CMS Web Interface CARE Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Numeratr NOTE: - The intent f the measure is t ensure that the physician, prescribing practitiner, registered nurse, r clinical pharmacist prviding n-ging care reviewed the discharge medicatins frm the inpatient facility. If thers perfrm the medicatin recnciliatin there must be dcumentatin that the physician, prescribing practitiner, registered nurse, r clinical pharmacist prviding n-ging care is aware f the review - Medicatin recnciliatin pst discharge may be cmpleted during a telehealth encunter CMS Web Interface V2.0 Page 9 f 20 11/13/2017

10 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the CMS Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. CMS Web Interface V2.0 Page 10 f 20 11/13/2017

11 Appendix I: Perfrmance Calculatin Flw Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f "In Hspice", "Mved ut f Cuntry", "Deceased", r "HMO Enrllment", will nly need t be dne nce per patient. Start* Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Medical Recrd Fund Yes Mark apprpriately fr cmpletin and STOP ABSTRACTION. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. N Patient Qualified fr the Sample. IF NOT, Select the Reasn & Enter Date** Patient Became Ineligible fr Sample (In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment) Yes Cntinue t Measure Cnf *See the Measure Submissin Dcument fr further instructins n hw t reprt this measure **If date is unknwn, enter 12/31/ CMS Web Interface V2.0 Page 11 f 20 11/13/2017

12 Measure Cnfirmatin Flw fr CARE-1 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Start* Cmplete pre-ppulated inpatient discharge infrmatin fr cnsecutively ranked patients if aged 18 years and lder at the beginning f the measurement perid** Mark apprpriately fr cmpletin and STOP ABSTRACTION. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. N Patient Qualified fr the Measure. IF NOT, Select: N - Other CMS Apprved Reasn fr Patient Disqualificatin*** Yes Cntinue t Measure Flw *See the Measure Submissin Dcument fr further instructins n hw t reprt this measure. **Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the CARE-1 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. *** Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv CMS Web Interface V2.0 Page 12 f 20 11/13/2017

13 Measure Flw fr CARE-1 Nte: This measure applies t each inpatient discharge Start* The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatin. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the CARE Cding Dcument. N Mark apprpriately fr cmpletin and STOP ABSTRACTION fr this inpatient discharge. Discharge is remved frm the perfrmance calculatins fr this measure. Patient Discharged frm Inpatient Facility n the discharge date listed +/- Tw Calendar Days Yes Discharge Medicatins Recnciled with Current Medicatin List in the Outpatient Medical Recrd within 30 Days Fllwing this Inpatient Facility Discharge Yes Perfrmance Met: Include in Perfrmance Numeratr (i.e., 609 Discharges) a N N Patient Seen Within 30 Days Fllwing this Inpatient Facility Discharge Perfrmance Nt Met: D Nt Include in Numeratr Yes Include Remainder f Discharges Listed in CMS Web Interface Fr Patient s that were Cnsecutively Cnfirmed and Cmpleted fr this Measure in the Denminatr (i.e., 750 Discharges) d SAMPLE CALCULATION: Perfrmance Rate= Perfrmance Met (a = 609 Discharges) 609 Discharges = 81.20% Denminatr (d= 750 Discharges) = 750 Discharges CALCULATION MAY CHANGE PENDING PERFORMANCE MET ABOVE *See the Measure Submissin Dcument fr further instructins n hw t submit this measure CMS Web Interface V2.0 Page 13 f 20 11/13/2017

14 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr CARE-1. CMS Web Interface V2.0 Page 14 f 20 11/13/2017

15 Measure Cnfirmatin Flw fr CARE-1 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Submissin Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr CARE-1. Cmplete pre-ppulated discharge infrmatin fr cnsecutively ranked patients aged 18 years and lder at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the CMS Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the CARE-1 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at qpp@cms.hhs.gv. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue t the CARE-1 measure flw. CMS Web Interface V2.0 Page 15 f 20 11/13/2017

16 Measure Flw fr CARE-1 Nte: This measure applies t each patient discharge The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the CARE Cding Dcument. 1. Start prcessing CARE-1 (NQF 0097) Flw fr the patients that qualified fr sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr Care Check t determine if the patient was discharged frm an inpatient facility n the listed discharge date (plus r minus tw calendar days). a. If n, the patient was nt discharged frm an inpatient facility n the listed discharge date (plus r minus tw calendar days), mark apprpriately fr cmpletin and stp abstractin fr this discharge. Discharge is remved frm the perfrmance calculatin fr this measure. b. If yes, the patient was discharged frm an inpatient facility n the listed discharge date (plus r minus tw calendar days), cntinue prcessing. 3. Check t determine if the patient was seen in the ffice/clinic within 30 days fllwing this inpatient facility discharge. a. If n, the patient was nt seen in the ffice/clinic within 30 days fllwing this inpatient facility discharge, mark apprpriately fr cmpletin and stp abstractin fr this discharge. Discharge is remved frm the perfrmance calculatin fr this measure. b. If yes, the patient was seen in the ffice/clinic within 30 days fllwing this inpatient facility discharge, this discharge will be included in the denminatr fr perfrmance rate calculatins. Nte: Include remainder f discharges listed in the CMS Web Interface fr patients that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these discharges wuld fall int the d categry (eligible denminatr, i.e. 750 discharges). Cntinue prcessing. 4. Check t determine if the discharge medicatins were recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge. a. If n, the discharge medicatins were nt recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge, perfrmance is nt met and shuld nt be included in the numeratr. Stp prcessing. b. If yes, the discharge medicatins were recnciled with the current medicatin list in the utpatient medical recrd within 30 days fllwing this inpatient facility discharge, perfrmance is met and this discharge will be included in the numeratr. Fr the sample calculatin in the flw these discharges wuld fall int the a categry (numeratr, i.e. 609 discharges). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a in the measure flw (609 discharges) Denminatr is categry d in measure flw (750 discharges) 609 (Perfrmance Met) divided by 750 (Eligible Denminatr) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met CMS Web Interface V2.0 Page 16 f 20 11/13/2017

17 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the CMS Web Interface CARE Cding Dcument. *CARE-1: Medicatin Recnciliatin Pst-Discharge Measure Cmpnent/Excel Data Element Variable Name Cding Tab System(s) Denminatr/Encunter Cdes Hspital Discharge HOSP_DIS_CODE C4 SNM Office Visit ENCOUNTER_CODE C4 HCPCS SNM Numeratr/Numeratr Cdes Medicatins MED_RECON_CODE C4 Recnciled SNM *Fr EHR mapping, the cding within CARE-1 is cnsidered t be all inclusive CMS Web Interface V2.0 Page 17 f 20 11/13/2017

18 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: Medicatins are ften changed while a patient is hspitalized. Cntinuity between inpatient and n-ging care is essential. CLINICAL RECOMMENDATION STATEMENTS: Medicatin recnciliatin pst-discharge is an imprtant step t catch ptentially harmful missins r changes in prescribed medicatins, particularly in elderly patients that are prescribed a greater quantity and variety f medicatins (Leape, 1991). Althugh the magnitude f the effect f medicatin recnciliatin alne n patient utcmes is nt well studied, there is agreement amng experts that ptential benefits utweigh the harm (Cleman, 2003; Prnvst, 2003; IOM, 2002; IOM, 2006). Medicatin recnciliatin pst-discharge is recmmended by the Jint Cmmissin patient safety gals (Kienle, 2008), the American Geriatric Sciety (Cleman, 2003), Sciety f Hspital Medicine (Kripalani, 2007; Grennwald, 2010), ACOVE (Assessing Care f Vulnerable Elders; Knight, 2001), and the Task Frce n Medicines Partnership (2005). Additinally, measurement f medicatin recnciliatin pstdischarge has been cited by the Natinal Quality Frum and the Natinal Pririties Partnership as a measurement pririty area (NQF, 2010) N trials f the effects f physician acknwledgment f medicatins pst-discharge were fund. Hwever, patients are likely t have their medicatins changed during a hspitalizatin. Estimates suggest that 46% f medicatin errrs ccur n admissin r discharge frm a hspital (Prnvst, 2003). Therefre, medicatin recnciliatin is a critical piece f care crdinatin pst-discharge fr all individuals wh use prescriptin medicatins. Prescriptin medicatin use is cmmn amng adults f all ages, particularly lder adults and adults with chrnic cnditins. On average, 82% f adults in the U.S. are taking at least ne medicatin (prescriptin r nnprescriptin, vitamin/mineral, herbal/natural supplement); 29% are taking five r mre. Older adults are the biggest cnsumers f medicatins with 17-19% f peple 65 and lder taking at least ten medicatins in a given week (Slne Survey, 2006). One bservatinal study shwed that 1.5 new medicatins were initiated per patient during hspitalizatin, and 28% f chrnic medicatins were canceled by the time f hspital discharge. Anther bservatinal study shwed that at ne week pst-discharge, 72% f elderly patients were taking incrrectly at least ne medicatin started in the inpatient setting, and 32% f medicatins were nt being taken at all. One survey study faulted the quality f discharge cmmunicatin as cntributing t early hspital readmissin, althugh this study did nt implicate medicatin discntinuity as the cause. (ACOVE) Implementing rutine medicatin recnciliatin after discharge frm an inpatient facility is an imprtant step t ensure medicatin errrs are addressed and patients understand their new medicatins. The prcess f reslving discrepancies in a patient s medicatin list reduces the risk f these adverse drug interactins being verlked and helps physicians minimize the duplicatin and cmplexity f the patient s medicatin regimen (Wenger, 2004). This in turn may increase patient adherence t the medicatin regimen and reduce hspital readmissin rates. First, a medicatin list must be cllected. It is imprtant t knw what medicatins the patient has been taking r receiving prir t the utpatient visit in rder t prvide quality care. This applies regardless f the setting frm which the patient came hme, lng-term care, assisted living, etc. The medicatin list shuld include all medicatins (prescriptins, ver-the-cunter, herbals, supplements, etc.) with dse, frequency, rute, and reasn fr taking it. It is als imprtant t verify whether the patient is actually taking the medicatin as prescribed r instructed, as smetimes this is nt the case. At the end f the utpatient visit, a clinician needs t verify three questins: 1) Based n what ccurred in the visit, shuld any medicatin that the patient was taking r receiving prir t the visit be discntinued r altered? 2) Based n what ccurred in the visit, shuld any prir medicatin be suspended pending cnsultatin with the prescriber? CMS Web Interface V2.0 Page 18 f 20 11/13/2017

19 3) Have any new prescriptins been added tday? These questins shuld be reviewed by the physician wh cmpleted the prcedure, r the physician wh evaluated and treated the patient. If the answer t all three questins is n, the prcess is cmplete. If the answer t any questin is yes, the patient needs t receive clear instructins abut what t d all changes, hlds, and discntinuatins f medicatins shuld be specifically nted. Include any fllwup required, such as calling r making appintments with ther practitiners and a timeframe fr ding s Institute fr Healthcare Imprvement (IHI) CMS Web Interface V2.0 Page 19 f 20 11/13/2017

20 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT The measures and specificatins were develped by and are wned by the Natinal Cmmittee fr Quality Assurance ( NCQA ). NCQA hlds a cpyright in the measures and specificatins and may rescind r alter these measures and specificatins at any time. Users f the measures and specificatins shall nt have the right t alter, enhance r therwise mdify the measures and specificatins, and shall nt disassemble, recmpile r reverse engineer the measures and specificatins. Anyne desiring t use r reprduce the materials withut mdificatin fr a nn-cmmercial purpse may d s withut btaining any apprval frm NCQA. All cmmercial uses r requests fr alteratin f the measures and specificatins must be apprved by NCQA and are subject t a license at the discretin f NCQA. The measures and specificatins are nt clinical guidelines, d nt establish a standard f medical care and have nt been tested fr all ptential applicatins. The measures and specificatins are prvided as is withut warranty f any kind. NCQA makes n representatins, warranties r endrsements abut the quality f any prduct, test r prtcl identified as numeratr cmpliant r therwise identified as meeting the requirements f a measure r specificatin. NCQA als makes n representatins, warranties r endrsements abut the quality f any rganizatin r clinician wh uses r reprts perfrmance measures. NCQA has n liability t anyne wh relies n measures and specificatins r data reflective f perfrmance under such measures and specificatins Natinal Cmmittee fr Quality Assurance, all rights reserved. Perfrmance measures develped by NCQA fr CMS may lk different frm the measures slely created and wned by NCQA. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. NCQA disclaims all liability fr use r accuracy f any cding cntained in the specificatins. The American Medical Assciatin hlds a cpyright t the CPT cdes cntained in the measures specificatins. CMS Web Interface V2.0 Page 20 f 20 11/13/2017