How to Attest for MIPS - 2017 AMERICAN OPTOMETRIC ASSOCIATION QUALITY IMPROVEMENT AND REGISTRY COMMITTEE
S TE P 1 Register For A CMS Enterprise (EIDM) Account Before a user can report data for the Quality Payment Program (QPP), the provider must have a CMS Enterprise (EIDM) account. To apply for an account, please navigate to: https:// portal.cms.gov/wps/portal/unauthportal/selfservice/ newuserregistration For additional help with registering for an Enterprise account, please reference this CMS help document. 1
S TE P 2 Navigate To QPP Portal Manual reporting (not through a registry) is performed by navigating to the Quality Payment Program (QPP) Portal. This is found at www.qpp.cms.gov In the upper right-hand corner, click the words Sign In (submit and manage data) 2
S TE P 3 Login With EIDM As indicated, the user will need to login with their EIDM account. Before completing, there is a checkbox that must be checked to agree with the statement of truth. Further, twofactor authentication is used by sending a six-digit code to the user s cell phone, that must then be entered to gain access. 3
S TE P 4 Review Account Dashboard On the QPP account dashboard, a user may see multiple practices if the provider is associated with more than one TIN. If there is more than one provider in a practice, a decision will need to be made if reporting As a group or As an individual. Most optometrists will likely report as an individual. 4
S TE P 5 Scroll Through Account Dashboard There are two options for reporting: as individuals and as a group. Since group reporting is very similar to individual reporting, this guide will walk through the steps of individual reporting. Start by scrolling down the dashboard web page until the link is seen in the photo above. There may not be an option to report as a group and the only option may be to report as an individual. Click the link, As individuals 5
S TE P 6 Decide What To Report Once under the individual clinician account, there are reporting options for: Quality Measures Advancing Care Information Improvement Activities If you have an EHR and wish to report Quality measures, click Quality Measures If you do not have an EHR, skip to Step 13 to submit Improvement Activities 6
S TE P 7 Options To Report Quality Measures To report Quality measures, there are two options: QRDA III file upload (from a file generated with CEHRT) Registry reporting For registry reporting, the EHR must be connected to a registry such as AOA MORE and submission/attestation takes place through the registry. For a file upload of QRDA III, click the file upload button 7
For Claims Data, as soon as a provider clicks on the Quality measures, there will be a section that shows the claims data as shown in the graphic below (arrow pointing to the Claims data score). 8
S TE P 8 Select QRDA III File To Upload The pop-up dialogue box appears after clicking on the file upload button. The submitter should have already exported the appropriate QRDA III file from his EHR (for instructions on how to perform the export, please seek help from the specific EHR vendor). Click the browse blue link to find the file for upload. 9
S TE P 9 Finish Upload Of QRDA III File From the previous step, after selecting the QRDA III file, it will appear in the dialogue box as indicated by the circle above. The submitter will then need to click the upload button (denoted by the arrow above) or click the green upload all button. 10
S TE P 10 Reporting ACI For those with an EHR and wishing to report ACI, continue onward. From the dashboard page, click the link for Advancing Care Information (arrow). If you do not have an EHR, skip to Step 13 to submit Improvement Activities 11
S TE P 11 Decide How To Report ACI There are two options for reporting ACI. One is a file upload from a report generated by the submitter s EHR (denoted by the arrow). For those unable to generate the appropriate file from an EHR, manual submission is necessary. Start by entering the dates of the performance period (denoted in the picture by the star). 12
S TE P 12 Manual Reporting Of ACI Next decide which measure set to submit: 2017 Advancing Care Information Transition Measures/ Modified Stage 2/2014 CEHRT Advancing Care Information Measures/Stage 3/2015 CEHRT Combination of Both Measure Sets If the submitter s EHR is not 2015 CEHRT, then the option is to select the transition measures (denoted by the circle above) 13
Continue with the submission process starting first answering the three attestation questions. If the submitter does not answer yes to the first two questions, then the process cannot be continued. The thrid question is optional and does not require a yes/no answer. Once these are answered successfully, the submitter will need the report of the individual measures from the clinician s EHR. The submitter will go through each category and enter the values from the EHR report into the corresponding fields on the remaining portion of the page. For help with obtaining the appropriate ACI report, finding the CEHRT version, and matching report numbers with the manual entry fields on the QPP website, please contact the individual EHR vendor for support. 14
S TE P 13 Reporting Improvement Activities (IA s) From the Clinician dashboard on the QPP website, click the link for Improvement Activities to begin reporting (denoted by the arrow). 15
S TE P 14 Reporting Improvement Activities Begin by selecting the date range for the performance period of the Improvement Activities. For the 2017 performance year, this must be at least 90 days. Once the date is selected, Improvement Activities can be attested. This can be performed one of two ways. The first is searching the activities via the search box (denoted by the star). The other is simply to scroll through the list and look for the particular Improvement Activity for which the submitter wishes to attest. 16
S TE P 15 Attestation Of Improvement Activities Attestation of Improvement Activities is simply clicking the word Yes next to the Improvement Activity. Clinicians should retain some written proof of completion of the Improvement Activity that can be provided in the event of an audit. Improvement Activities can also be submitted through the AOA MORE registry through attestation. This is performed on the AOA MORE website and not through the QPP portal. 17
How To Attest For MIPS 2017 2018 American Optometric Association Quality Improvement and Registry Committee xviii