QPP APM Entity (APP)
The top section of this page are your population and hierarchy filters. These filters will update both the Gaps in Care charts and the patient grid below.
You can filter by Population (Which includes your Medicare and Non-Medicare populations available to you and configured in Health Endeavors), division, if you use divisions, TIN, SubGroup and NPI. If you are a division, SubGroup or practice level user, you will only have access to view the patients assigned to you.
You have the option to select a single population or multiple or use the 'Select All'
option under each filter to select the full population.
The default view in QPP APM Entity Interface shows only reportable patients. This means the total amount of patients who meet the denominator criteria specified by CMS for each measure. In Health Endeavors, those are all patients with a Qualifying Encounter AND Performance Met (C) or Performance Not Met (CNP) or Exception (EXP) or Incomplete (INC) status.
You also have the option to search for a specific name or TIN/NPI number in each field by typing in the filter box and the smart filter will narrow the results for you to choose.
Once you have completed your population selection, click the button.
If you would like to clear a specific selection you can use the 'Clear' button under the selection box or
in the upper left of the section to return back to the default settings.
Below the Population and Hierarchy Filters are your Gaps in Care charts.
The Gaps in Care Charts will only show you patients in the Reportable Population. (Those patients who meet the denominator criteria specified by CMS for each measure. In Health Endeavors, those are all patients with a Qualifying Encounter AND Performance Met (C) or Performance Not Met (CNP) or Exception (EXP) or Incomplete (INC) status.)
Data Completeness Requirement - ACOs must report at least 70 % of their total patients who meet the measure's denominator criteria, regardless of payer (Medicare and Non-Medicare). That means, that out of the total amount of patients who meet the denominator criteria, the measure is reported for at least 70% of those patients. Charts will show data completeness rate in RED if below 70% or GREEN if equal or higher than 70%.
Use the button to export the charts.
To filter patients in your chart click on either the chart or the legend below the chart. Once you click on a chart the other charts will be hidden from view.
To go back to view all measures, click on and all charts will re-appear.
You can also choose at the top of the page and you will
be returned back to default settings.
Below the Gaps in Care charts are your grid filters.
The grid filters will NOT update your charts. Grid filters will only update the patient grid below. Grid filters are your patient specific filters, (First Name, Last Name, Member ID, Gender, MRN, Birth Date or Deceased/Living).
From the Data Source drop down you can search for measures answered with claims, EMR imports by date or a specific file, and manual entries by date and/or user that entered the manual response.
We have also given you the ability to view the Non-Reportable population. These are patients that DO NOT meet the denominator criteria specified by CMS for a measure, e.g. do not have a qualifying encounter, do not have a required diagnosis etc.
You will need to click on the toggle button and click search to view these patients. Click the toggle button again and click search to return to the reportable population.
This option is available as some of these patients may move to the reportable population during the performance period.
The patient grid gives you an option to export your report to excel by clicking on the 'Export to Excel' button.
Clicking on the 'Columns' button gives you the ability to hide columns you do not want to view.
The number of patients from your filters will be listed in the upper right-hand corner of the grid.
Click on the page icon in the 'Actions' column to view the patient lookup screen to view claims and patient details.
Member ID, MRN, First Name, Last Name, DOB, Gender, Population, Division, TIN Name , TIN, Sub-TIN, Provider Name and NPI columns can all be sorted by clicking in the header of the column.
To update a measure manually, click on the current response
for the patient measure you are reviewing. A pop-up screen will appear. You will be able to enter a response or review the current response.
If the current response is NQ (Not Qualified) due to age, you will not be able to make any changes to the response. You will see the following message at the bottom of the pop-up:
To make updates on a response that has already been answered via claims or EMR , make sure that the QPP import chart (only available to Security Official users) has Manual as the first priority, or you will be unable to make any changes for that measure. You will see the following message at the bottom of the pop-up:
From the pop-up you will be able to see the Answer Source (Claims, Manual, etc..)
To view the claims associated with the current response you can click on the 'View Claims' button in the pop-up screen. The claim codes that are being used to answer the current response are bolded. If you need more details, you can click on the page icon in the action column.
Once you have made the desired changes choose the 'Save' button at the bottom of the pop-up. If you are not making any changes you can click the 'X' in the upper right-hand corner of the pop-up to close.
At the bottom of the page is a legend with all the response codes you will find in the grid.