Medicaid PI Quick Start: HIE Clinical Information Reconciliation

Measure Overview	Medicaid Goal
This measure reports the referral or transitions of care in which a patient is seen for the first time, referred into the practice, or is an existing patient who already has a summary of care document saved to their chart, and the provider performs a clinical information reconciliation using the information from the patient or from an electronic summary of care document, including the following three clinical information sets: Medication, Medication Allergy, and Current Problem list.	Must Exceed 80%

Measure Overview

Medicaid Goal

This measure reports the referral or transitions of care in which a patient is seen for the first time, referred into the practice, or is an existing patient who already has a summary of care document saved to their chart, and the provider performs a clinical information reconciliation using the information from the patient or from an electronic summary of care document, including the following three clinical information sets: Medication, Medication Allergy, and Current Problem list.

Must Exceed 80%

Setup Requirements
This measure requires the following setup: The Reference Documents Section must be added to the Facesheet. The method by which your organization will import CCDs must be configured. Users must have the Reconcile Reference Documents user right.

Setup Requirements

This measure requires the following setup:

The Reference Documents Section must be added to the Facesheet.
The method by which your organization will import CCDs must be configured.
Users must have the Reconcile Reference Documents user right.

Denominator
Transitions of care or referrals indicated by any of the following: A new patient visit indicated by an E&M code added at the same time or after the start of the visit in the range of 99201-99205 or 99381-99387. The code must be in the Plan or E&M section of a note linked to a visit that occurred during the measurement period. A referral or transition into the practice indicated by the Inbound Referral/Transition check box selected under Referrals in the Plan section of the Note. This Note must be linked to a visit that occurred during the measurement period, and the check box must be selected at the same time or after the start of the visit. A summary of care document/CCD is in the Reference Documents section. The import date for the document can be any time before the end of the visit. The document must be linked to the visit.

Denominator

Transitions of care or referrals indicated by any of the following:

A new patient visit indicated by an E&M code added at the same time or after the start of the visit in the range of 99201-99205 or 99381-99387. The code must be in the Plan or E&M section of a note linked to a visit that occurred during the measurement period.
A referral or transition into the practice indicated by the Inbound Referral/Transition check box selected under Referrals in the Plan section of the Note. This Note must be linked to a visit that occurred during the measurement period, and the check box must be selected at the same time or after the start of the visit.
A summary of care document/CCD is in the Reference Documents section. The import date for the document can be any time before the end of the visit. The document must be linked to the visit.

Numerator
Transitions of care or referrals where: The provider performed a Medications, Medication Allergies, and Current Problems reconciliation during the same visit. The visit used to perform the reconciliations is the patient’s first visit and occurred during the measurement period set in Prime Suite Reporting 2020. The reconciliations occurred during or after the visit was checked-in and linked but within the measurement period set in Prime Suite Reporting 2020. The patient's summary of care document is linked to the qualifying visit when automatically reconciling data.

Numerator

Transitions of care or referrals where:

The provider performed a Medications, Medication Allergies, and Current Problems reconciliation during the same visit.
The visit used to perform the reconciliations is the patient’s first visit and occurred during the measurement period set in Prime Suite Reporting 2020.
The reconciliations occurred during or after the visit was checked-in and linked but within the measurement period set in Prime Suite Reporting 2020.
The patient's summary of care document is linked to the qualifying visit when automatically reconciling data.