| Updates | Today is the deadline to complete the opt-in process for MY 2025.
Use the Analytics & Reporting (AR) application on the Provider Engagement, Analytics & Reporting (PEAR) portal to complete the opt-in process. Review the QIPS Opt-in User Guide for step-by-step instructions. Practices must complete the opt-in process annually to participate in the Quality Incentive Payment System (QIPS) program. Failure to opt-in will exclude your office from the program in measurement year (MY) 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note: You must complete the annual Satisfaction Survey (it's required) prior to opting in. If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025. TIP: Identify the Office and Clinical Champions before you begin for a smoother process. QIPS MY 2025 changes For an overview of the changes to the QIPS program for MY 2025, please review the update posted below on December 30, 2024. More details of the MY 2025 changes will be provided in the upcoming QIPS program guide for MY 2025. Questions For more information regarding the QIPS opt-in process, please email Jennifer Kennedy. If your question is of a clinical nature, please contact Ellen Riccobene, M.D. or Luz Ramos, M.D.
| 1/31/2025 | | Updates | Two weeks left to opt in to the QIPS program for MY 2025
The deadline to complete the opt-in process is Friday, January 31, 2025.
QIPS MY 2025 changes For an overview of the changes to the QIPS program for measurement year (MY) 2025, please review the update posted below on December 30, 2024. More details of the MY 2025 changes will be provided in the upcoming
QIPS program guide for MY 2025.
How to opt in Use the Analytics & Reporting (AR) application on the
Provider Engagement, Analytics & Reporting (PEAR) portal to complete the opt-in process. Practices must complete the opt-in process annually to participate in the Quality Incentive Payment System (QIPS) program. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note: You must complete the annual Satisfaction Survey (it's required) prior to opting in.
Review these resources to help you during the opt-in process: -
QIPS Program Guide. The guide for MY 2025 will soon be available on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
-
QIPS Opt-in User Guide. A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025.
TIP: Identify the Office and Clinical Champions
before you begin for a smoother process.
For more information regarding the QIPS opt-in process, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
| 1/17/2025 | | Updates | Don't forget to opt in to the QIPS program for MY 2025
The deadline to complete the opt-in process is Friday, January 31, 2025.
QIPS MY 2025 changes For an overview of the changes to the QIPS program for measurement year (MY) 2025, please review the update posted below on December 30, 2024.
More details of the MY 2025 changes will be provided in the upcoming
QIPS program guide for MY 2025.
How to opt in Use the Analytics & Reporting (AR) application on the
PEAR portal to complete the opt-in process. Practices must complete the opt-in process annually to participate in the Quality Incentive Payment System (QIPS) program. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note, completion of the annual Satisfaction Survey is required prior to opting in.
Review these resources to help you during the opt-in process: -
QIPS Program Guide. The guide for MY 2025 will soon be available on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
-
QIPS Opt-in User Guide. A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025.
TIP: Identify the Office and Clinical Champions
before you begin for a smoother process.
For more information regarding the QIPS opt-in process, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
| 1/7/2025 | | Updates | Updates to the QIPS program – MY 2025 A summary of changes to the Quality Incentive Payments System (QIPS) program for measurement year (MY) 2025 was posted below on October 7, 2024. We are sharing a few additional changes that were recently made – see those marked in blue. We are working to finalize the QIPS MY 2025 program guide, which will be published in January 2025. Important update: We notified providers on November 19, 2024, that the Keystone HMO Children's Health Insurance Program (CHIP) product will transition from Keystone Health Plan East, Inc. to its affiliate Vista Health Plan, Inc. (d/b/a Keystone First) on July 1, 2025. Keystone First membership is not included in the QIPS program. For the QIPS program, please keep in mind that membership eligibility requirements do apply, and the program measurement year's payments are based on the participating membership at the time of payment. QIPS MY 2025 – Adult program changes The following incentives/measures will be retired: - Engagement Incentive program – The final payment for those practices eligible in 2024 was in December 2024.
- Improvement Incentive
- Other clinical quality measures (measures within the Quality Performance Measure [QPM] score program). This measure consists of the following HEDIS® measures:
- Osteoporosis management in women who had a fracture
- Avoidance of antibiotic treatments for adults with acute bronchitis
- Persistence of beta blocker treatment after a heart attack
Note: The Well-care visits will become a stand-alone measure.
- Primary Care Visit Measure – this measure correlates to the HEDIS measure Adults' Access to Preventive/Ambulatory Health Services (AAP)
- QPM score program feedback – more information on how to submit feedback in 2025 is detailed below. Note: This change also applies to the Pediatric program.
Updates to measure combinations and new measures addedThe following measures will be assessed independent of each other versus a combination measure: - Diabetic Care. You will have an opportunity to earn incentives on four distinct measures versus one.
- Glycemic Status assessment for patients with diabetes will become two measures, measuring the Commercial population different than the Medicare Advantage population:
- Commercial – Glycemic status assessment for patients with diabetes <8.0 percent
- Medicare Advantage – Glycemic status assessment for patients with diabetes <9.0 percent – NEW for 2025
- Eye Exam
- Kidney Health Evaluation
- Medication Management. You will have an opportunity to earn incentives on six measures versus one. The following are the measures included in this category:
- Commercial – Statin therapy for patients with diabetes (SPD) - Dispensed
- Medicare Advantage – Statin Use in Patients with Diabetes (SUPD) - Adherence – NEW for 2025
- Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
- Medication Adherence for cholesterol
- Medication Adherence for hypertension
- Medication Adherence for diabetes medications
Retirement of QPM Feedback
The QPM score program feedback process is retiring for MY 2025. This means that all gap closures must be closed in the measurement year; there will not be an opportunity to provide additional information after the measurement year ends. Note: The QPM feedback process will still be available for MY 2024. This will occur in the second quarter of 2025.
How to close gaps in care: - Ensure your office staff are using all the available reporting on PEAR Analytics & Reporting to identify open care gaps (i.e., Attributed Member Snapshot, Gaps in Care report).
- Please use the Gap Closures Guides for both Pediatrics and Adults. The guides are available in the PEAR Help Center under Value-Based Programs. These guides provide measure-specific information related to the clinical quality measures.
- Submit claims in a timely manner leveraging appropriate coding when applicable. Reference the Gap Closure Guides for guidance.
- If you are an Epic Payer partner, established Epic Payer Platform connections will automatically share clinical encounter level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match.
- Utilize PEAR Comprehensive Visit to submit gap closures for your Medicare Advantage and Affordable Care Act populations.
- If any of the above are not an option, please use the following:
- Fax line: 215-761-0258. The fax MUST include a cover sheet with the name of the practice submitting the information and the care gaps they are trying to close.
- Use Globalscape to submit your information. If you don't already have an established link, please contact Sheila Burton.
If there are any questions about these changes, please email Jennifer Kennedy. If your question is of a clinical nature, please contact Ellen Riccobene, M.D. or Luz Ramos, M.D.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission. | 12/30/2024 | | Updates | Reminder: Opt in to the QIPS program for MY 2025
The deadline to complete the opt-in process is January 31, 2025. QIPS MY 2025 changes For an overview of some of the changes to the QIPS program for measurement year (MY) 2025, please review the update posted below on October 7, 2024. More details of the MY 2025 changes will be provided in an upcoming communication and the QIPS program guide for MY 2025. How to opt in Use the Analytics & Reporting (AR) application on the PEAR portal to complete the opt-in process. Practices must complete the opt-in process annually to participate in the Quality Incentive Payment System (QIPS) program. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note, completion of the annual Satisfaction Survey is required prior to opting in.
Review these resources to help you during the opt-in process: - QIPS Program Guide. The guide for MY 2025 will soon be available on the PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
- QIPS Opt-in User Guide. A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025. TIP: Identify the Office and Clinical Champions before you begin for a smoother process. For more information regarding the QIPS opt-in process, please email Jennifer Kennedy. If your question is of a clinical nature, please contact Ellen Riccobene, M.D. or Luz Ramos, M.D.
| 12/2/2024 | | Updates | Don't forget: Opt in to the QIPS program for MY 2025
Primary care practices may submit a request to participate in the Quality Incentive Payment System (QIPS) program for MY 2025.
The deadline to complete the opt-in process is January 31, 2025.
QIPS MY 2025 changes For an overview of the changes to the QIPS program for MY 2025, please review the update posted below on October 7, 2024. Details of these changes will be provided in the
QIPS program guide for MY 2025, which will be available towards the end of 2024.
How to opt in Use the Analytics & Reporting (AR) application on the
PEAR portal to complete the opt-in process. Practices must complete the opt-in process annually to participate. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note: We have extended the opt-in period to the end of January. Going forward, opt in will occur from October 1 to January 31 of the following year. Note, completion of the annual Satisfaction Survey is required prior to opting in. We encourage all personnel (clinical and administrative staff) to complete the survey so we can capture well-rounded feedback.
Review these resources to help you during the opt-in process: -
QIPS Program Guide. The guide for MY 2025 will soon be available on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
-
QIPS Opt-in User Guide.
A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025.
TIP: Identify the Office and Clinical Champions
before you begin for a smoother process.
For more information regarding the QIPS opt-in process, please email
Jennifer Kennedy.If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D. | 11/1/2024 | | Updates | | 10/29/2024 | | Updates | Top quality recognition
Independence Blue Cross congratulates these primary care offices for achieving top quality practice recognition in the Quality Performance Measure (QPM) score program, a component of the Quality Incentive Payment System (QIPS) program, for measurement year (MY) 2023. These practices achieved either of the following for MY 2023: - Adult practices. An overall mean performance band of less than or equal to 2.5 (lower is better), had no quality measures in the lowest band (band 5), and at least one quality measure in the highest band (band 1).
- Pediatric practices. An overall performance in the highest band (band 1) in both the vaccination and well-visit composite quality measures.
You can find details of the QPM score program, including the measures scored, in the QIPS Manual – measurement year 2023, which is available on the PEAR Help Center under Analytics & Reporting – Value-Based Programs.
| 10/14/2024 | | Updates |
QIPS MY 2025 program changes and opt-in process Please take the time to opt in for measurement year (MY) 2025 of the Quality Incentive Payment System (QIPS) program.
The deadline to complete the opt-in process is January 31, 2025. See more details below.
QIPS MY 2025 changes The QIPS program is evaluated throughout the year to ensure it provides high-value programs that deliver quality member experiences and outcomes. Therefore, we would like to highlight some changes to the QIPS program for MY 2025. Details of these changes will be provided in the
QIPS program guide for MY 2025, which will be available towards the end of 2024.
Adult program changes The following incentives/measures will be retired: - Engagement Incentive program – The final payment for those practices eligible in 2024 will be in December 2024. The final quarterly review is being done now and will be applied to the final quarter of this year (October – December 2024).
- Improvement Incentive
- Other clinical quality measures (measures within the Quality Performance Measure [QPM] score program). This measure consists of the following HEDIS® measures:
- Osteoporosis management in women who had a fracture
- Avoidance of antibiotic treatments for adults with acute bronchitis
- Persistence of beta blocker treatment after a heart attack
- Well-care visits (adult practices only)
The following measures will be assessed independent of each other versus combining the measures together into one combination measure: -
Diabetic Care. You will have an opportunity to earn incentives on four distinct measures versus one.
- Glycemic Status assessment for patients with diabetes will become two measures, measuring the Commercial population different than the Medicare Advantage population:
- Commercial – Glycemic status assessment for patients with diabetes <8.0 percent
- Medicare Advantage – Glycemic status assessment for patients with diabetes <9.0 percent
- Eye Exam
- Kidney Health Evaluation
-
Medication Management. You will have an opportunity to earn incentives on six measures versus one. The following are the measures that will make up this category:
- Statin therapy for patients with diabetes (SPD) - Dispensed – Will be measured on the Commercial population.
- Statin Use in Patients with Diabetes (SUPD) - Adherence – Will be measured on the Medicare Advantage population.
- Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
- Medication Adherence for cholesterol
- Medication Adherence for hypertension
- Medication Adherence for diabetes medications
Note: There are no changes for the pediatric program for MY 2025. Here is a high-level summary of the QPM measure changes compared to MY 2024.
1
| Breast Cancer Screening
| Aggregate
| Aggregate
| 2
| Colorectal Cancer Screening
| Aggregate
| Aggregate
| 3
| Cervical Cancer Screening
| Aggregate
| Aggregate
| 4
| Controlling High Blood Pressure
| Aggregate
| Aggregate
| 5
| Diabetes Care - Eye Exam
|
Combination measure; Aggregate population
| Aggregate
| 6
| Diabetes Care - HbA1c Good Control (<8%)
| Commercial only
| 7
| Diabetes Care - Kidney Health Evaluation
| Aggregate
| 8
| Diabetes Care - HbA1c Control (<=9%) - add to QIPS for Medicare Advantage only - NEW
| Medicare Advantage only
| 9
| Osteoporosis Management
| See Index 16
| Retire
| 10
| Statin Therapy for Patients with Diabetes - Dispensed (SPD)
|
Combination measure; Aggregate population
| Commercial only
| 11
| Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
| Aggregate
| 12
| Medication Adherence for Cholesterol
| Aggregate
| 13
| Medication Adherence for Hypertension
| Aggregate
| 14
| Medication Adherence for Diabetes Medications
| Aggregate
| 15
| Statin Use in Patients with Diabetes (SUPD) – Adherence - NEW
| Medicare Advantage only
| 16
| Other clinical quality measures composite (AAB, WCV, OMW, PBH)*
| Aggregate
| Retire
| 17
| Primary Care Visit
| Medicare Advantage
| Medicare Advantage
| 18
| Well Visit Composite (WV30, Childhood and Adolescence)
| Commercial
| Commercial
| 19
| Vaccination Composite (CIS, Adol)
| Commercial
| Commercial
|
Aggregate = Medicare Advantage and Commercial member population is combined; Combination = Multiple measures are combined into one.
*AAB =
Avoidance of antibiotic treatment for adults with acute bronchitis/bronchiolitis; WCV = Well-care visits;
OMW = Osteoporosis management in women who had a fracture; PBH =
Persistence of beta blocker treatment after a heart attack
How to opt in
Use the Analytics & Reporting (AR) application on the
PEAR portal to complete the opt-in process. Practices must complete the opt-in process annually to participate. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note: We have extended the opt-in period to the end of January. Going forward, opt in will occur from October 1 to January 31 of the following year. Note, completion of the annual Satisfaction Survey is required prior to opting in. We encourage all personnel (clinical and administrative staff) to complete the survey so we can capture well-rounded feedback.
Review these resources to help you during the opt-in process: -
QIPS Program Guide. The guide for MY 2025 will soon be available on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
-
QIPS Opt-in User Guide. A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025.
TIP: Identify the Office and Clinical Champions
before you begin for a smoother process.
For more information regarding the QIPS opt-in process, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
| 10/7/2024 | | Updates |
Use your PEAR report to identify and close W30 gaps in care To support providers in completing W30 Well Visits and closing W30 gaps in care, Independence Blue Cross (IBX) has developed a report that allows providers to see which of their pediatric patients (our members) need preventive W30 Well Visits or have gaps in clinical care in the first 30 months of life. Available on the Provider Engagement, Analytics & Reporting (PEAR) portal, this report indicates whether your pediatric patients are eligible for a W30 Well Visit, or if they have missed an important wellness visit and need additional support to catch up on immunizations and other key tests, such as lead testing.
Please note: Practices in the Quality Incentive Payment System (QIPS) program are eligible to receive an incentive for closing W30 gaps in care.
We all recognize the importance of well-child visits in early life:
-
Six or more well visits by age 15 months (W15)
-
One or two well visits by age 30 months (W30)
How to access your report:
Sign in to PEAR portal. Select the Analytics & Reporting application.
Go to Report Center.
Click Attributed Member Snapshot, select the practice of interest, and then click
"Select All" under
Select Data Category.
On the right-hand side, click
Submit.
Once the report has completed, go to Output Manager and download the report.
Find the column titled “Well child visits in first 30 months"
“Closed" means the patient is compliant for the measure; “Open" means the patient has a gap for the measure.
If you have questions about accessing your report, please contact PEAR Support at 1-833-444-PEAR (1-833-444-7327). For more information, please contact Joy-Pauline Binns at Joy.Binns@ibx.com.
| 9/10/2024 | | Quality Measures |
Quality Performance Measure (QPM) score program -NEW!
The Quality Performance Measure (QPM) score program component of QIPS offers incentives for services provided during the measurement year (January through December of the measurement year, unless otherwise noted) for the measures listed below. For additional information, review the QIPS program guide – measurement year 2024 on the PEAR Help Center under Analytics & Reporting – Value-Based Programs.
2024 Quality measures
Adult program - DTaP
- IPV
- HIB
- MMR
- VZV
- PCV
- Flu
- Rotavirus
| 12/13/2023 | | Updates |
QIPS program updates The following resources are now available in the
PEAR Help Center under Analytics & Reporting – Value-Based Programs for your review. Sign-in is required. -
QIPS Program Guide for MY 2024. Please note the highlighted changes below for MY 2024 and review the guide for more detail.
-
Quality targets. Based on updated CMS and NCQA national standards, the quality targets were updated in the Quality Performance Measure (QPM) score program for MY 2024.
-
QPM quality measures. The below highlights some important changes to the QPM quality measures for MY 2024. Please refer to the updated
Gap Closures Guides and the
Advanced Illness and Frailty Exclusion Guide in the
Help Center for more information about each measure.
- The former Hemoglobin A1c (HbA1c) Control for Patients with Diabetes measure was revised to Glycemic Status Assessment for Patients with Diabetes.
- Gender-inclusive language was added to Breast Cancer Screening and Cervical Cancer Screening.
- For QPM measures that pertain to diabetes (i.e., statin dispensed based on disease prevalence, eye exam), the denominator has been revised to include a diagnosis of diabetes when evaluating pharmacy claims and ≥2 encounters from any setting with a diabetes diagnosis.
-
QIPS opportunity chart. In Section 4 of the guide (page 11), an incentive opportunity chart has been added to provide the total earning opportunity available in the program.
-
QIPS Program Guide for MY 2023. The MY 2023 guide was revised to include the updated targets for Colorectal Cancer Screening. Earlier this year, a notification was sent to QIPS providers informing of the age change to 45 for colorectal cancer screening for MY 2023. National ratings were recently released to incorporate the adjusted age change. Therefore, the targets for MY 2023 were adjusted to reflect the new information.
Updated report For MY 2023, we introduced a new incentive for Medicare Advantage members: Transitions of Care: Follow-up after ED (emergency department) visit for members with multiple high-risk chronic conditions. A new field has been added to the
ED and UC Visit Analytics report to help you identify those patients with multiple chronic conditions who require a follow up. Please refer to the video available in the
Help Center for a refresher of this report.
Important reminder The opt-in window for MY 2024 is open. If you have not opted in and would like to be eligible and measured in QIPS 2024, please complete the opt-in process
by January 5, 2024. For more information regarding the QIPS program, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
| 12/13/2023 | | Reference Materials | | 10/9/2023 | | Updates |
New resource for the Rx Adherence and Usage report -
NEW!
A new guide is available that provides best practices for reviewing the Rx Adherence and Usage report on the PEAR Portal, in PEAR AR (Analytics & Reporting).
It shows you how to incorporate this information into your organization's workflow, to assist members who are eligible for the medication adherence measures in our QIPS program and Medicare's Five-Star Quality Rating Program (Stars Program). You can find the guide in the PEAR Help Center under Analytics & Reporting – QIPS/Stars Programs.
| 10/20/2022 | | Updates |
Revised Practice Financial Dashboard
We recently made changes to the presentation and data available in the Practice Financial Dashboard within the PEAR Analytics & Reporting application to make it easier to review your financial performance.
Earnings Summary: -
Data now displays for the current year and prior two years.
-
Payment types are presented in stacked bar charts. You can hover over each section to view the specific category totals.
-
The payment types are arranged alphabetically and align with the descriptions presented in the transaction registry. The registry remains segmented by category and check number.
Transaction registry: -
View payments by month and check number for each of the measures/payment types that are presented in the bar charts.
-
Certain measures will pay across multiple checks for payments driven by membership plans.
 Quality measures:
-
Your current QIPS opt-in status is clearly displayed.
-
Three new columns have been added: Current rate, Current band, and Remaining gaps.
-
The Current rate and Current band columns contain the same information that was previously presented as hover text.
-
The Remaining gaps column represents the number of members currently required to come into compliance to improve to the next band.
| 8/10/2022 | | Updates |
QPM alert: Closing Medication Reconciliation care gaps
Our data shows a concerning amount of open care gaps for Medication Reconciliation after patients are discharged from inpatient settings. While our data shows that patients are being seen for post-hospitalization follow-up, it also shows more open Medication Reconciliation care gaps.
If both of these pieces are not complete, this could negatively affect your Transitions of Care (TRC) QIPS incentive performance.
One of the following may be occurring for Medication Reconciliation: -
The medications are being reconciled post-discharge, but the appropriate coding is not taking place. Reference the table below for appropriate Medication Reconciliation codes.
-
The medications are not being reconciled post-discharge. They should be reviewed during the patient visit, and appropriate coding should take place.
How to identify members -
Access PEAR Analytics & Reporting
-
Under Population Health, select “Follow Up Items"
-
Navigate to “Recently Discharged Patients - within last 14 days"
-
A member roster will appear. Leverage the “i" icon for more information about the discharge.
What is needed to be compliant for TRC
TRC evaluates the percentage of members who are 18 and older and had each of the following: -
Notification of Inpatient Admission: Members who had documentation of notification of inpatient admission on the day of admission through 2 days after the admission.
-
Receipt of Discharge Information: Members who had documentation of discharge information on the day of discharge through 2 days after the discharge.
-
Patient Engagement After Inpatient Discharge: Members who had a form of patient engagement (office visit, visits to the home, telehealth) provided within 30 days after discharge. (QIPS)
-
Medication Reconciliation Post-Discharge: Members who had documentation of medication reconciliation on the date of discharge through 30 days after discharge. (QIPS)
How to close the care gap
1. Patient Engagement Code: See section 1 below.
-AND-
2. Medication Reconciliation Code: See section 2 below.
-THEN-
3. Submit a claim/encounter with appropriate coding from the below tables.
Note: If the discharge is followed by a readmission or direct transfer to an acute or nonacute inpatient care setting on the date of discharge through 30 days after discharge (31 days total), use the admit date from the first admission and the discharge date from the last discharge.
Resubmission of claims
A corrected claim can be submitted to include the Medication Reconciliation code. This is only applicable when the appropriate medication reconciliation took place during a patient follow-up visit. Please refer to the Claim investigation and corrected claim submission procedures article for further information.
Need help?
Access the Gap Closures Guide on the PEAR Help Center to learn more about closing care gaps for the TRC measure. | 7/12/2022 |
|