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Your Healthmonix MIPSpro dashboard contains a comprehensive description of the codes and criteria for each measure. Click on the View Details to see more.
Description
Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred.
Instructions
This measure is to be submitted a minimum of once per performance period for the first referral for all patients during the measurement period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure for the patients for whom a referral was made during the measurement period based on the services provided and the measure-specific denominator coding. The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure. All MIPS eligible clinicians reporting on this measure should note that all data for the reporting year is to be submitted by the deadline established by CMS, however, only first referrals made between January 1 - October 31 (the measurement period) will count towards the denominator to allow adequate time for the referring clinician to collect the consult report by the end of the performance period. When clinicians to whom patients are referred communicate the consult report as soon as possible with the referring clinicians, it ensures that the communication loop is closed in a timely manner and that the data is included in the submission to CMS.
NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.
Measurement Submission Type
Measure data may be submitted by individual MIPS-eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS-eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
Number of patients, regardless of age, who had an encounter during the performance period and were referred by one clinician to another clinician on or before October 31.
DENOMINATOR NOTE: If there are multiple referrals for a patient during the performance period, use the first referral.
AND
Patient encounter during the performance period (CPT): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*
AND
The patient was referred to another provider or specialist during the performance period: G9968
CPT and HCPCS codes can be entered into the billing section for the encounter. Below is an example from the appointment window.
Numerator
Number of patients with a referral on or before October 31, for which the referring clinician received a report from the clinician to whom the patient was referred.
Definitions:
Referral: A request from one clinician to another clinician for evaluation, treatment, or co-management of a patient's condition. This term encompasses “referral” and consultation as defined by Centers for Medicare & Medicaid Services.
Report: A written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician.
NUMERATOR NOTE: The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring clinician which pertain to a particular referral, use the first consultant report to satisfy the measure.
The clinician to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same clinician who would report on the measure.
Numerator Options: The following codes can be entered in the HCPCS code section for the visit.
Performance Met:
The provider who referred the patient to another provider received a report from the provider to whom the patient was referred (G9969)
OR
Performance Not Met:
The provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred (G9970)
