Under the Merit-Based Incentive Payment System (MIPS) pathway of the MACRA Quality Payment Program, Promoting Interoperability (PI) is one of the four performance categories that will be considered and weighted for scoring an eligible clinician’s performance under MIPS.
In 2018, there are 2 measure set options for submission depending on the Certified EHR Technology (CEHRT) edition a clinician is using:
Promoting Interoperability Measures
Promoting Interoperability (PI) Transition Measures
Depending on the CEHRT Edition, there will be different objectives from which the MIPS eligible clinician may choose to report. This article outlines the measure details and specifications for the 2018 PI Transition Measure: Specialized Registry Reporting.
PI Transition Measures
Public Health Reporting
Specialized Registry Reporting
The MIPS eligible clinician is in active engagement to submit data to a specialized registry.
YES/NO: To meet this measure, MIPS eligible clinicians must attest YES to being in active engagement to submit data to a specialized registry.
Note: Eligible clinicians must earn the full base score in order to earn additional credit through the ACI bonus score.
CMS has indicated that active engagement may be demonstrated in one of the following ways:
Completed Registration to Submit Data: The MIPS eligible clinician registered to submit data with the public health agency (PHA) or, where applicable, the clinical data registry (CDR) to which the information is being submitted; registration was completed within 60 days after the start of the MIPS performance period; and the MIPS eligible clinician is awaiting an invitation from the PHA or CDR to begin testing and validation.
This option allows MIPS eligible clinicians to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process.
MIPS eligible clinicians who have registered in previous years do not need to submit an additional registration to meet this requirement for each MIPS performance period.
Testing and Validation: The MIPS eligible clinician is in the process of testing and validation of the electronic submission of data.
MIPS eligible clinicians must respond to requests from the PHA or, where applicable, the CDR within 30 days.
Production: The MIPS eligible clinician has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.
For information on meeting the requirements of this measure in Practice Fusion, see the Practice Fusion Suggested Workflow section below.
Measure Requirements: Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you meet the workflow requirements for this measure within the Practice Fusion EHR.
Register with the specialized registry to which you plan to submit data. For details on how CMS has defined a specialized registry, refer to FAQ #22517.
Contact your selected specialized registry (or registries) to confirm the registry data submission method and requirements.
Practice Fusion supports the following data types that can be submitted to a specialized registry:
CCDA .xml files
Immunization HL7 2.5.1
Syndromic Surveillance HL7 2.5.1
To maintain active engagement with the specialized registry, continue the data submission process for all applicable patients using the registry’s specified data submission method. Active engagement is defined above under Scoring Requirements.
Retain documentation that confirms your submissions to the specialized registry for at least 6 years as required by the CMS document retention policy.
Review the CMS measure specifications for more information about the requirements for this measure.
For more information on the Merit-Based Incentive Payment System (MIPS) program, you can visit Practice Fusion’s Quality Payment Program Center.
- CMS also provides further resources about the Quality Payment Program here.