2019 MIPS Measure #46: Medication Reconciliation Post-Discharge

Valid Data Submission Method(s) Measure Type High Priority Measure? NQS Domain
Claims, CMS Web Interface, Registry Process Yes Communication and Care Coordination

Measure Description

The percentage of discharges from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years and older of age seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record.
This measure is reported as three rates stratified by age group:
Submission Criteria 1: 18-64 years of age
Submission Criteria 2: 65 years and older
Total Rate: All patients 18 years of age and older

Instruction

This measure is to be submitted at an outpatient visit occurring within 30 days of each inpatient facility discharge date during the performance period. This measure is appropriate for use in the ambulatory setting only. There is no diagnosis associated with this measure. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. This measure is not to be submitted unless a patient has been discharged from an inpatient facility within 30 days prior to the outpatient visit.

This measure will be calculated with 3 performance rates:

  • Performance Rate 1: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18-64 years of age seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on- going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record

AND

  • Performance Rate 2: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 65 years and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on- going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record

AND

  • Total Rate (Overall Performance Rate): Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Denominator

All discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care.

DENOMINATOR NOTE: This denominator is based on discharges followed by an office visit, not patients. Patients may appear in the denominator more than once if there was more than one discharge followed by an office visit in the performance period.

Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients 18-64 years of age on date of encounter

SUBMISSION CRITERIA 2: Patients aged 65 years and older on date of encounter  SUBMISSION CRITERIA 3: All Patients 18 years of age and older

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0402, G0438, G0439

AND

Patient discharged from an inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) within the last 30 days

AND NOT

DENOMINATOR EXCLUSION:

Patient had hospice services any time during the measurement period: G9691

Numerator

NUMERATOR (SUBMISSION CRITERIA 1 & 2 & 3):

Medication reconciliation conducted by a prescribing practitioner, clinical pharmacists or registered nurse on or within 30 days of discharge.

Definition:

Medication Reconciliation – A type of review in which the discharge medications are reconciled with the most recent medication list in the outpatient medical record. Documentation in the outpatient medical record must include evidence of medication reconciliation and the date on which it was performed. Any of the following evidence meets criteria: (1) Documentation of the current medications with a notation that references the discharge medications (e.g., no changes in meds since discharge, same meds at discharge, discontinue all discharge meds), (2) Documentation of the patient’s current medications with a notation that the discharge medications were reviewed, (3) Documentation that the provider “reconciled the current and discharge meds,” (4) Documentation of a current medication list, a discharge medication list and notation that the appropriate practitioner type reviewed both lists on the same date of service, (5) Notation that no medications were prescribed or ordered upon discharge; (6) Documentation that patient was seen for postdischarge follow-up with evidence of medication reconciliation or review, (7) Documentation in the discharge summary that the discharge medications were reconciled with the current medications; the discharge summary must be in the outpatient chart.

NUMERATOR NOTE: Medication reconciliation should be completed and documented on or within 30 days of discharge. If the patient has an eligible discharge but medication reconciliation is not performed and documented within 30 days, submit 1111F with 8P.

Numerator Options:

Performance Met:

Discharge medications reconciled with the current medication list in outpatient medical record (1111F)

OR

Performance Not Met:

Discharge medications not reconciled with the current medication list in outpatient medical record, reason not otherwise specified (1111F with 8P)

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Instructions

This measure is to be submitted at an outpatient visit occurring within 30 days of each inpatient facility discharge date during the performance period. This measure is appropriate for use in the ambulatory setting only. There is no diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. This measure is not to be submitted unless a patient has been discharged from an inpatient facility within 30 days prior to the outpatient visit.

This measure will be calculated with 3 performance rates:

  1. Performance Rate 1: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18-64 years of age seen within 30 days following dischargein the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on- going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record
  2. Performance Rate 2: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 65 years and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on- going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record
  3. Total Rate (Overall Performance Rate): Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record

Measure 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

All discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care

DENOMINATOR NOTE: This denominator is based on discharges followed by an office visit, not patients. Patients may appear in the denominator more than once if there was more than one discharge followed by an office visit in the performance period.

Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients 18-64 years of age on date of encounter

SUBMISSION CRITERIA 2: Patients aged 65 years and older on date of encounter

SUBMISSION CRITERIA 3: All Patients 18 years of age and older

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0402, G0438, G0439

AND

Patient discharged from an inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) within the last 30 days

AND NOT

DENOMINATOR EXCLUSION:

Patient had hospice services any time during the measurement period: G9691

Numerator

NUMERATOR (SUBMISSION CRITERIA 1 & 2 & 3):

Medication reconciliation conducted by a prescribing practitioner, clinical pharmacists or registered nurse on or within 30 days of discharge

Definition:

Medication Reconciliation – A type of review in which the discharge medications are reconciled with the most recent medication list in the outpatient medical record. Documentation in the outpatient medical record must include evidence of medication reconciliation and the date on which it was performed. Any of the following evidence meets criteria: (1) Documentation of the current medications with a notation that references the discharge medications (e.g., no changes in meds since discharge, same meds at discharge, discontinue all discharge meds), (2) Documentation of the patient’s current medications with a notation that the discharge medications were reviewed, (3) Documentation that the provider “reconciled the current and discharge meds,” (4) Documentation of a current medication list, a discharge medication list and notation that the appropriate practitioner type reviewed both lists on the same date of service, (5) Notation that no medications were prescribed or ordered upon discharge; (6) Documentation that patient was seen for post- discharge follow-up with evidence of medication reconciliation or review, (7) Documentation in the discharge summary that the discharge medications were reconciled with the current medications; the discharge summary must be in the outpatient chart.

NUMERATOR NOTE: Medication reconciliation should be completed and documented on or within 30 days of discharge. If the patient has an eligible discharge but medication reconciliation is not performed and documented within 30 days, submit 1111F with 8P.

Numerator Options:

Performance Met: Discharge medications reconciled with the current medication list in outpatient medical record (1111F)

OR

Performance Not Met: Discharge medications not reconciled with the current medication list in outpatient medical record, reason not otherwise specified (1111F with 8P)