2016 Measures Group (MG) Flow Sleep Apnea
|
|
|
- Amos Hudson
- 5 years ago
- Views:
Transcription
1
2
3
4 2016 Measures Group (MG) Flow Sleep Apnea Please refer to the specific section of the 2016 PQRS Measures Groups Specifications Manual to identify the specific coding and instructions to report the Sleep Apnea Measures Group including Patient Sample Criteria (denominator), individual measures, and numerator options information for use in reporting this Measures Group. 1. Start with G8900 Intent G-code if Utilized 2. Check Patient Age: a. If the Age is greater than or equal to 18 years of age at Date of Service equals No, do not include in Eligible Population/Denominator. Stop Processing. b. If the Age is greater than or equal to 18 years of age at Date of Service equals Yes, proceed to check Patient Diagnosis. 3. Check Patient Diagnosis: a. If Diagnosis indicating Sleep Apnea as listed in the Measures Group Patient Sample Criteria equals No, do not include in Eligible Population/Denominator. Stop Processing. b. If Diagnosis indicating Sleep Apnea as listed in the Measures Group Patient Sample Criteria equals Yes, proceed to check Encounter Performed. 4. Check Encounter Performed: a. If Encounter as Listed in the Measures Group Patient Sample Criteria equals No, do not include in Eligible Population/Denominator. Stop Processing. b. If Encounter as Listed in the Measures Group Patient Sample Criteria equals Yes, include in the Eligible Population/Denominator. 5. Denominator Population a. Include in Eligible Population/Denominator all eligible patients who meet the Patient Sample Criteria (denominator) for the Measures Group. For each measure within the measures group each numerator option is represented by a letter which is used in the Scenarios for Reporting and Performance Algorithms at the end of this document. 6. Start Numerator Options for Measures within the Measures Group 7. Composite Quality Data Code (QDC) G8759 has been created for registries that utilize claims data. This QDC may be reported in lieu of individual QDCs when all quality clinical actions for all applicable measures within the group have been performed for this patient. 8. Measure 128 a. Measure #128 does not need to be reported (is not applicable) if the patient is not eligible for BMI calculation or follow-up plan. See the Sleep Apnea Measures Group Overview for reasons for which the patient would be considered ineligible for the measure. When measure #128 is Not Applicable it is represented by letter e i in the Scenarios for Reporting Algorithms.
5 b. Numerator option Performance Met has an arrow pointing to G8759 Composite Quality Data Code (QDC) or Equivalent. Performance Met is represented by letter a i. c. Numerator option Performance Not Met is represented by letter c i. d. Numerator option Not Reported is represented by letter d i. 9. Measure 130 or Equivalent. Performance Met is represented by letter a ii. b. Numerator option Performance Exclusion is represented by letter b ii. c. Numerator option Performance Not Met is represented by letter c ii. d. Numerator option Not Reported is represented by letter d ii. 10. Measure 226 or Equivalent. Performance Met is represented by letter a iii. b. Numerator option Performance Exclusion is represented by letter b iii. c. Numerator option Performance Not Met is represented by letter c iii. d. Numerator option Not Reported is represented by letter d iii. 11. Measure 276 or Equivalent. Performance Met is represented by letter a iv. b. Numerator option Performance Exclusion is represented by letter b iv. c. Numerator option Performance Not Met is represented by letter c iv. d. Numerator option Not Reported is represented by letter d iv. 12. Measure 277 or Equivalent. Performance Met is represented by letter a v. b. Numerator option Performance Exclusion is represented by letter b v. c. Numerator option Performance Not Met is represented by letter c v. d. Numerator option Not Reported is represented by letter d v.
6 13. Measure 278 or Equivalent. Performance Met is represented by letter a vi. b. Numerator option Performance Exclusion is represented by letter b vi. c. Numerator option Performance Not Met is represented by letter c vi. d. Numerator option Not Reported is represented by letter d vi. 14. Measure 279 or Equivalent. Performance Met is represented by letter a vii. b. Numerator option Performance Exclusion is represented by letter b vii. c. Numerator option Performance Not Met is represented by letter c vii. d. Numerator option Not Reported is represented by letter d vii. 15. Scenarios for Reporting and Performance Algorithms 16. Patient X a. Patient X Not Applicable for Measure 128 (represented by e i ) b. Patient X Met Measure 130 (represented by a ii ) c. Patient X Met Measure 226 (represented by a iii ) d. Patient X Met Measure 276 (represented by a iv ) e. Patient X Met Measure 277 (represented by a v ) f. Patient X Exclusion Reported for Measure 278 (represented by b vi ) g. Patient X Met Measure 279 (represented by a vii ) 17. Patient Y a. Patient Y Met Measure 128 (represented by a i ) b. Patient Y Met Measure 130 (represented by a ii ) c. Patient Y Not Met but Reported Measure 226 (represented by c iii ) d. Patient Y Met Measure 276 (represented by a iv ) e. Patient Y Met Measure 277 (represented by a v ) f. Patient Y Not Met but Reported Measure 278 (represented by c vi ) g. Patient Y Met Measure 279 (represented by a vii )
7 18. Patient Z a. Patient Z Met Measure 128 (represented by a i ) b. Patient Z Met Measure 130 (represented by a ii ) c. Patient Z Met Measure 226 (represented by a iii ) d. Patient Z did Not Report Measure 276 (represented by d iv ) e. Patient Z Met Measure 277 (represented by a v ) f. Patient Z Met Measure 278 (represented by a vi ) g. Patient Z Met Measure 279 (represented by a vii ) 19. Reporting Algorithm a. Reporting of all applicable measures contained in the measures group, per eligible patient, equals one b. Patient X Reporting equals 1 Plus Patient Y Reporting equals 1 Plus Patient Z Reporting equals 0 for a total of 2 of the Required 20 Patient Sample Reported 20. Performance Algorithms 21. Measure 128 a. Performance Met equals 2 divided by Reported QDC for 2 eligible patients equals 100% Performance Rate 22. Measure 130 a. Performance Met equals 3 divided by Reported QDC for 3 eligible patients minus 0 Performance Exclusions equals 100% Performance Rate 23. Measure 226 a. Performance Met equals 2 divided by Reported QDC for 3 eligible patients minus 0 Performance Exclusions equals 66.67% Performance Rate 24. Measure 276 a. Performance Met equals 2 divided by Reported QDC for 2 eligible patients minus 0 Performance Exclusions equals 100% Performance Rate 25. Measure 277 a. Performance Met equals 3 divided by Reported QDC for 3 eligible patients minus 0 Performance Exclusions equals 100% Performance Rate 26. Measure 278 a. Performance Met equals 1 divided by Reported QDC for 3 eligible patients minus 1 Performance Exclusions equals 50% Performance Rate
8 27. Measure 279 a. Performance Met equals 3 divided by Reported QDC for 3 eligible patients minus 0 Performance Exclusions equals 100% Performance Rate
2016 Measures Group (MG) Flow Diabetic Retinopathy
2016 Measures Group (MG) Flow Diabetic Retinopathy Please refer to the specific section of the 2016 PQRS Measures Groups Specifications Manual to identify specific coding and instructions to report the
2016 Measures Group (MG) Flow Cataracts
2016 Measures Group (MG) Flow Cataracts Please refer to the specific section of the 2016 PQRS Measures Groups Specifications Manual to identify specific coding and instructions to report the Cataracts
2016 Measures Group (MG) Flow Cardiovascular Prevention
2016 Measures Group (MG) Flow Cardiovascular Prevention Please refer to the specific section of the 2016 PQRS Measures Groups Specifications Manual to identify specific coding and instructions to report
2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes 01/23/2014
2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes 01/23/2014 CPT only copyright 2013 American Medical Association. All rights reserved. CPT is a registered
Measure #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques National Quality Strategy Domain: Effective Clinical Care
Measure #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes 12/13/2013
2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes 12/13/2013 CPT only copyright 2013 American Medical Association. All rights reserved. CPT is a registered
2013 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes
2013 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual Release Notes 03/04/2013 CPT only copyright 2012 American Medical Association. All rights reserved. CPT is a registered
2016 Physician Quality Reporting System (PQRS)
2016 Physician Quality Reporting System (PQRS) Virtual Office Hour Session Measure-Applicability Validation (MAV) 301 Sophia Autrey, MPH, CHES Research Analyst Center for Clinical Standards and Quality,
2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
Measure #433: Proportion of Patients Sustaining a Major Viscus Injury at the time of any Pelvic Organ Prolapse Repair National Quality Strategy Domain: Patient Safety 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES:
Automated exposure control Adjustment of the ma and/or kv according to patient size
Quality ID #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
2018 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for Registry Submission of Individual Measures
2018 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for Registry Submission of Individual Measures Utilized by Individual Eligible Clinicians for Registry Submissions or Clinical
2019 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for Medicare Part B Claims Measures
2019 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for Medicare Part B Claims Measures Utilized by Merit-based Incentive Payment System (MIPS) Eligible Clinicians 11/20/2018
2019 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for MIPS Clinical Quality Measures (CQMs)
2019 Quality Payment Program (QPP) Measure Specification and Measure Flow Guide for MIPS Clinical Quality Measures (CQMs) Utilized by Merit-based Incentive Payment System (MIPS) Eligible Clinicians, Groups,
PQRS - The Basics PQRS Physician Quality Reporting System. Presented by: Marcy Le
PQRS - The Basics 2014 PQRS Physician Quality Reporting System Presented by: Marcy Le WHY TALK ABOUT PQRS? WHY DO WE CARE ABOUT THIS? 2014 is the last year that incentive money is available **incentive
National Provider Call:
National Provider Call: Physician Quality Reporting System (Physician Quality Reporting) and Electronic Prescribing (erx) Incentive Program May 22, 2012 Disclaimers This presentation was current at the
DENOMINATOR: All final reports for patients, regardless of age, undergoing a CT procedure
Measure #359: Optimizing Patient Exposure to Ionizing Radiation: Utilization of a Standardized Nomenclature for Computed Tomography (CT) Imaging Description National Quality Strategy Domain: Communication
Self-Employed Income ON DEMAND. Liquidity Quiz
Self-Employed Income ON DEMAND 1. What is the definition of Liquidity? A. The ability to convert inventory into cash B. The ability of a company to sell its assets C. The ability of a company to meet its
BARIATRIC SURGERY PROGRAM APPLICATION Updated: 1/2018 Page 1 of 6
Updated: 1/2018 Page 1 of 6 Date: SELF Last Name: First: MI: Maiden: Home #: Cell #: Work #: Date of Birth: SSN#: Gender: Male Female Marital Status: Married Divorced Widowed Separated Never Married White
2014 Physician Quality Reporting System (PQRS): Implementation Guide 10/17/2014
2014 Physician Quality Reporting System (PQRS): Implementation Guide 10/17/2014 CPT only copyright 2013 American Medical Association. All rights reserved. Page 1 of 43 Table of Contents Page Introduction
Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA:
Key Financial and Operational Impacts from the Proposed Rule to Implement MACRA: The proposed rule implementing Access and CHIP Reauthorization Act of 2015 (MACRA) was made available on May 9, 2016. A
On Track for MACRA The Provider s Guide to QPP
On Track for MACRA The Provider s Guide to QPP Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222 San Jose, CA 95117 www.prognocis.com training@bizmaticsinc.com Copyright 2017 Bizmatics, Inc. Overview CMS
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Naglazyme) Reference Number: CP.PHAR.161 Effective Date: 02.16 Last Review Date: 05.18 Line of Business: Commercial, HIM, Medicaid Coding Implications Revision Log See Important Reminder
Data Analytics Solutions
Data Analytics Solutions Controlling health, measuring performance and assessing risk all start with data analytics. BenRx s comprehensive Data Analytics solutions give employers the advanced analytical
PQRS Questions & Answers
PQRS Questions & Answers Follow up from CAP s PQRS Webinar December 2011 GENERAL QUESTIONS Eligibility Q: Are these quality measures required if you do professional billing only? A: The measures only apply
2012 Physician Quality Reporting Measures Groups Specifications Manual Release Notes 11/10/2011
2012 Physician Quality Reporting Measures Groups Specifications Manual Release Notes 11/10/2011 CPT only copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark
Drug Prior Authorization Form Pomalyst (pomalidomide)
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
DENOMINATOR: All final reports for patients, regardless of age, undergoing a CT procedure
Measure #363: Optimizing Patient Exposure to Ionizing Radiation: Search for Prior Computed Tomography (CT) Studies Through a Secure, Authorized, Media-Free, Shared Archive National Quality Strategy Domain:
Inspire Therapy for Sleep Apnea Patient Insurance Support Program
Inspire Therapy for Sleep Apnea Patient Insurance Support Program Working with your physician and your health plan to secure approval for Inspire therapy 1-844-515-6182 An Inspire therapy-trained doctor
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) REVIEW I. MIPS Overview 1) Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) i) Signed into Law
Drug Prior Authorization Form Neulasta (pegfilgrastim)
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Drug Prior Authorization Form Ocrevus (ocrelizumab)
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
PRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016
PRIMER: MACRA and the Merit-based Incentive Payment System (MIPS) Tara O Neill Hayes January 31, 2016 Background On April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into
2010 Physician Quality Reporting Initiative Implementation Guide
2010 Physician Quality Reporting Initiative Implementation Guide Page 1 of 22 Table of Contents Introduction PQRI Measure Selection Considerations PQRI Denominators and Numerators Claims-Based Reporting
User Guide 2015 Physician Quality Reporting System (PQRS) Payment Adjustment Feedback Report
User Guide 2015 Physician Quality Reporting System (PQRS) Payment Adjustment Feedback Report Page 1 of 16 Disclaimer This information was current at the time it was published or uploaded onto the web.
2018 Quality Measure Benchmarks Overview
2018 Quality Benchmarks Overview What Are Quality Benchmarks? When a clinician or group submits measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is
CY 2014 Physician Quality Reporting System (PQRS)
CY 2014 Physician Quality Reporting System (PQRS) 101 Table of Contents Step 1: Understand PQRS and how it impacts you A. When was PQRS first established and implemented? B. What is PQRS? C. How does CMS
Sunflower Health Plan. Regional Provider Workshop
Sunflower Health Plan Regional Provider Workshop Agenda & Objectives e Third Party Liability (TPL) & Coordination of Benefits (COB) Claims Submission Requirements Overview Sunflower TPL & COB Claims Processing
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Iclusig) Reference Number: CP.PHAR.112 Effective Date: 06.01.13 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Edluar, Intermezzo, Zolpimist) Reference Number: CP.PMN.172 Effective Date: 12.01.18 Last Review Date: 11.18 Line of Business: Commercial, Medicaid See Important Reminder at the end of
Tuesday, January 7, :00 Noon EST Dial In: Meeting ID: No audio available through Webinar
CMS 2014 Physician Quality Reporting System (PQRS) Webinar Tuesday, January 7, 2014 12:00 Noon EST Dial In: 1-877-267-1577 Meeting ID: 992 953 262 No audio available through Webinar Introduction 2 Series
Clinical Policy: Belatacept (Nulojix) Reference Number: CP.PHAR.201 Effective Date: Last Review Date: Line of Business: Medicaid
Clinical Policy: (Nulojix) Reference Number: CP.PHAR.201 Effective Date: 03.01.16 Last Review Date: 11.17 Line of Business: Medicaid Coding Implications Revision Log See Important Reminder at the end of
One Stop Medical Center Tel:
PATIENT DEMOGRAPHICS TODAY S DATE PATIENT NAME BIRTHDATE AGE SEX M F ADDRESS CITY STATE ZIP HOME#( ) CELL#( ) WORK #( ) May OSMC leave a message on your: Home Phone: y n Work: y n Cell : y n MARITAL STATUS
Health chain. Vidushi Savant, MD Stanford University / Savant Care 401 Quarry Rd Stanford, CA 94305
Health chain Can healthcare be fixed with blockchain tech? (Working paper) For comments email: vsavant@stanford.edu Vidushi Savant, MD Stanford University / Savant Care 401 Quarry Rd Stanford, CA 94305
C Copyright NIHON KOHDEN CORPORATION All Rights Reserved
C Copyright NIHON KOHDEN CORPORATION All Rights Reserved Overall sales increased 3.1% to 111.6 billion. Operating income was 7.2 billion, ordinary income was 7.5 billion, and income attributable to owners
Medicare Advantage Value-Based Insurance Design Model Test. Responses to Stakeholder Inquiries. Last updated: November 10, 2015
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE AND MEDICAID INNOVATION Medicare Advantage Value-Based
Novel Changes in Bundled Payments Cleveland Clinic Experience. Joseph Cacchione, M.D. Chairman, HVI Strategic Operations
Novel Changes in Bundled Payments Cleveland Clinic Experience Joseph Cacchione, M.D. Chairman, HVI Strategic Operations Background Healthcare costs account for 17.2% of the GDP* Traditional payment methods
Value Based Pay for Performance. Lindsay Erickson Pay for Performance Summit March 2, 2015
Value Based Pay for Performance Lindsay Erickson Pay for Performance Summit March 2, 2015 Objectives IHA & California P4P Value Based P4P design and development Observations as we go live Copyright 2014
Clinical Policy: Suvorexant (Belsomra) Reference Number: CP.PMN.109 Effective Date: Last Review Date: Line of Business: HIM, Medicaid
Clinical Policy: (Belsomra) Reference Number: CP.PMN.109 Effective Date: 02.01.17 Last Review Date: 11.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy for
NYU Langone Weight Management Program WHAT DO I NEED TO SCHEDULE MY SURGERY? AS SOON AS YOU GET HOME CALL YOUR INSURANCE!
NYU Langone Weight Management Program WHAT DO I NEED TO SCHEDULE MY SURGERY? AS SOON AS YOU GET HOME CALL YOUR INSURANCE! Procedure Codes: Laparoscopic Gastric Banding 43770 Laparoscopic Gastric Bypass
Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL
Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL Practice Structure Office Management Physician Encounter Billing Office Physicians & Administrator
Chapter 2 Section 2.6. Data Requirements - Institutional/Non-Institutional Record Data Elements (M - O)
TRICARE Systems Manual 7950.2-M, February 1, 2008 TRICARE Encounter Data (TED) Chapter 2 Section 2.6 Data Requirements - Institutional/Non-Institutional Record Data Elements (M - O) ELEMENT NAME: NATIONAL
Claim Preparation and Filing Overview for U.S.
Claim Preparation and Filing Overview for U.S. During the course of a patient visit, invoices will be created by various staff within the office. It is recommended that when an insurance invoice is created
UHHS P&P. University Hospitals Health System Policy & Procedure Manual. Physician Employment
Page # 1 of 6 UHHS P&P University Hospitals Health System Policy & Procedure Manual Physician Employment SCOPE This Policy applies to University Hospitals Health System, Inc. and all of its wholly-owned
Drug Prior Authorization Form
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
Why do we conduct therapy reassessment visits? o
HCHB Frequently Asked Questions: Therapy Reassessment Why do we conduct therapy reassessment visits? o Under the 2011 Home Health PPS Final Rule, CMS has detailed new requirements that home health agencies
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Personal Accident & Sickness
Personal Accident & Sickness Claim Form IMPORTANT NOTICES INSURER AND AGENT The contract of insurance is arranged by Winsure Underwriting Pty Ltd ( Winsure ) (ABN 68 169 336 252, AR No. 459637), an Authorised
Current Status Of Legislation on Quality Bench Marks
Conflicts of Interest Current Status Of Legislation on Quality Bench Marks None Sean P. Roddy, MD Albany, NY Reason For Quality Measures Progressive increase in healthcare costs under the fee-for-service
Medicare Advantage Measurement Period Handbook For Enhanced Personal Health Care
Medicare Advantage Measurement Period Handbook For Enhanced Personal Health Care Measurement Period beginning: 01/01/18 Version 010118 Introduction: Welcome to your Medicare Advantage Measurement Period
Clinical Policy: Brand Name Override Reference Number: CP.PMN.22 Effective Date: Last Review Date: 02.18
Clinical Policy: Reference Number: CP.PMN.22 Effective Date: 09.01.06 Last Review Date: 02.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory
Aligning PQRS and Meaningful Use. Maximize your Medicare Reimbursement
Aligning PQRS and Meaningful Use Maximize your Medicare Reimbursement INTRODUCTION Brux McClellan, MPH, MHA Project Coordinator, HealthInsight Payment Adjustments Incentive $$ & Payment Adjustments Value
Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Certified Respiratory Care Practitioner (CRCP) Services Handbook
Texas Medicaid Provider Procedures Manual Provider Handbooks October 2018 Certified Respiratory Care Practitioner (CRCP) Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims
Application For Compassionate Assistance Loan Claimant's Statement
Application For Compassionate Assistance Loan Claimant's Statement Instructions to Insured Person/Owner The insured person must be terminally ill with a life expectancy of 24 months or less. Eligibility
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Drug Prior Authorization Form
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Answers to Frequently Asked Questions Comprehensive Quality & Risk Program
Answers to Frequently Asked Questions Comprehensive Quality & Risk Program What is the Comprehensive Quality & Risk Program? The Comprehensive Quality & Risk Program is a chronic conditions quality of
CSHCN Services Program Prior Authorization Request for Pulse Oximeter Form and Instructions
Pulse Oximeter Form and Instructions General Information Ensure the most recent version of the Prior Authorization Request for Pulse Oximeter form is submitted. The form is available on the TMHP website
Drug Prior Authorization Form Actemra (tocilizumab)
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Drug Prior Authorization Form The purpose of this form is to obtain information required
State Employees and Teachers Indemnity Plan. Summer Provider Conferences 2007
State Employees and Teachers Indemnity Plan Summer Provider Conferences 2007 The North Carolina General Assembly The NC General Assembly is currently in its long session scheduled through mid to late summer
Indirect Cost Rates A Non-Profit Perspective. Alex Weekes Principal ML Weekes & Company, PC
Indirect Cost Rates A Non-Profit Perspective Alex Weekes Principal ML Weekes & Company, PC 203-458-0872 alex.weekes@mlweekes.com Agenda Old School versus new regulations Review of 2CFR 200 (not so new
Financial Assistance Sheena Olson (Managed Care Contracts Manager)
Title: Financial Assistance Owner: Sheena Olson (Managed Care Contracts Manager) Recommending Group: Patient Financial Services Oversight Group: Administrative Policy & Procedure Committee Oversight Review
Name: Date of Birth: Age: Sex:
PATIENT INFORMATION Name: Date of Birth: Age: Sex: Address: (Cit, State, Zip) Billing Address: SSN: Primary Phone #: Work Phone #: Secondary Phone #: Email: Referring Physician: Employment: Full/Part/None
OCF-21B*: CREATE INVOICE FROM PREVIOUSLY SUBMITTED OCF-18 PLAN MANUAL FOR WEB USERS. *Comparable to OCF-21A
OCF-21B*: CREATE INVOICE FROM PREVIOUSLY SUBMITTED OCF-18 PLAN MANUAL FOR WEB USERS *Comparable to OCF-21A July 2012 Table of Contents WHEN DO I USE AN OCF 21B... 4 WHAT IS INCLUDED IN THIS MANUAL?...
Quality Payment Program Year 2
Quality Payment Program Year 2 MIPS Highlights Raising the performance threshold to 15 points in Year 2 (from 3 points in the transition year). Allowing the use of 2014 Edition and/or 2015 Certified Electronic
Integrated Impact Assessment Report for Clinical Commissioning Policies
Integrated Impact Assessment Report for Clinical Commissioning Policies Policy Reference Number Policy Title Accountable Commissioner F05X02 Treatment of iron overload for transfused and non transfused
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the
Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management
This document contains both information and form fields. To read information, use the Down Arrow from a form field. Prior Authorization, Pharmacy and Health Case Management Information The purpose of this
Predictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis?
Predictive Qualifying Alternative Payment Model (APM) Participants (QPs) Methodology Fact Sheet What is the Predictive QP Status Analysis? One of the Quality Payment Program s goals is to be clear about
We look forward to meeting you, and will be available for you at any time. Dr. Douglas Scott, M.D. Dr. Kirk Johnson, M.D.
Welcome to Orthopedic Associates of the Lowcountry. Thank you for your confidence in allowing us to help care for your health. It is a responsibility we respect, and take very seriously. Please take the
Outpatient Code Editor (OCE) Clinical Edits
TE TE 001 001-Invalid diagnosis code = Medicare Default 002 002-Diagnosis and age conflict = Health Plan will not apply this 003 003-Diagnosis and sex conflict Changed from effective (process) date 8/7/2018
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Synribo) Reference Number: CP.PHAR.108 Effective Date: 04.01.13 Last Review Date: 05.18 Line of Business: Commercial, HIM, Medicaid Coding Implications Revision Log See Important Reminder
Portal User Guide. Submitting Inpatient Notifications and Prior Authorization Requests. Tufts Health Together and Tufts Health Direct
MedHOK Provider Portal User Guide Submitting Inpatient Notifications and Prior Authorization Requests Tufts Health Together and Tufts Health Direct 06/2017 DMS XXXXXXX 1 MedHOK Provider Portal User Guide
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Xenazine) Reference Number: CP.PHAR.92 Effective Date: 12.01.11 Last Review Date: 05.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy for
Chapter 7. Unit 1: Overview - Fee-For-Service Payment
Chapter 7 Unit 1: Overview - Fee-For-Service Payment In This Unit Topic See Page Unit 1: Overview Fee-For Service Payment Introduction To The QualityBLUE Program Fee-For- 2 Service Payment QualityBLUE
Altabax (Retapamulin)
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization
Value Based Pay for Performance Results for Measurement Year September 2014
Value Based Pay for Performance Results for Measurement Year 2013 September 2014 Program Overview 2016 Integrated Healthcare Association. All rights reserved. 2 Value Based Pay for Performance 2016 Integrated
Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional
Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional REIMBURSEMENT POLICY Policy Number 2018R0085F Annual Approval Date 7/11/2018 Approved By Reimbursement Policy Oversight
Clinical Policy: Ruxolitinib (Jakafi) Reference Number: CP.PHAR.98 Effective Date: Last Review Date: 02.18
Clinical Policy: (Jakafi) Reference Number: CP.PHAR.98 Effective Date: 03.01.12 Last Review Date: 02.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
125Company Benefit Card Frequently Asked Questions
125Company Benefit Card Frequently Asked Questions What is the 125Company Benefit card? The 125Company Benefit Card is a special-purpose Visa Card that gives you an easy, automatic way to pay for eligible
Health Information Technology and Management
Health Information Technology and Management CHAPTER 11 Health Statistics, Research, and Quality Improvement Pretest (True/False) Children s asthma care is an example of one of the core measure sets for
C O D I N G & B I L L I N G F O R
HMI Cor poration Third Quarter 2009 September 30, 2009 C O D I N G & B I L L I N G F O R P R O S P E C T I V E P A Y M E N T S Y S T E M S October 2009 Update of the Hospital Outpatient Prospective Payment
Simplifying Fractions.notebook February 28, 2013
1 Fractions may have numerators and/or denominators that are composite numbers (numbers that have more factors than one and itself). When this is the case, fractions can be simplified to their lowest term.
State/Local Income Tax Refunds
State/Local Income Tax Refunds Form 1040 Line 10 Pub 4491 Part 3 The Interview Point of awareness returns NTTC Training 2014 2 1 State/Local Income Tax Refunds Form 1099 G State or local income tax refund
Medication Limitation of Non Coverage for Prevention Benefit Coverage with Waived Cost Share
Cost Share Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage Guideline must be
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.vsp.com or by calling 1-800-877-7195. Important Questions