IA multiple

[Dave Rhoadarmer]

My understanding is that for small practices, rural practices, or practices located in geographic health professional shortage areas (HPSAs), and non-patient facing MIPS eligible clinicians, the score will be doubled in computing the Improvement Activities performance category score.  The API is currently scoring without the multiple.  How can I force it to score with the 2x multiple for our doctors?

[biju joseph]

Hi Dave, 

Good morning! At the moment SubmisisonsAPI is not integrated with other systems at CMS. So, it is not possible to determine the exact special scoring eligibility of TIN/NPI. For testing purposes, the behavior is mocked using digits of a TIN. Given a fake TIN with 9 positions, e.g. "000-00-0000":

• The 4th position corresponds to Clinician Type
  

"000-1x-xxxx" - CertifiedRegisteredNursePractitioner

"000-2x-xxxx" - PhysiciansAssistant

"000-3x-xxxx" - CertifiedRegisteredNurseAnesthetists

"000-4x-xxxx" - ClinicalNurseSpecialist

Otherwise ignored

• The 5th position corresponds to Alternative Payment Models
  

"000-x1-xxxx" - in a non-ACO APM, e.g. "", does not score quality (re-weights quality to 0%)

"000-x2-xxxx" - in an ACO APM that does score quality (SSP all tracks, Next Gen ACO)

Otherwise, ignored

• The 6th position corresponds to ACI Reweighting Status
  

"000-xx-1xxx" - "pending"

"000-xx-2xxx" - "approved"

"000-xx-3xxx" - "denied"

Otherwise ignored

• The 7th, 8th and 9th positions (in any order) is used to determine the following:

SmallPractice = 2

RuralPractice = 3

InShortageArea = 4

LowVolumeExcluded = 5

NonPatientFacing = 6

AccreditedPatientCenteredMedicalHome = 7

ImprovementActivityStudyParticipant = 8

HospitalReporter = 9

For example:

"000-xx-x369" would mean is "RuralPractice", "NonPatientFacing" and "HospitalReporter" 

"000-xx-x936" same as above, would mean "RuralPractice", "NonPatientFacing" and "HospitalReporter" 

"000-xx-x200" would mean is only "SmallPractice" 

"000-xx-x000" would mean none of the above 

Best regards, 

Biju Joseph

[Dave Rhoadarmer]

Thanks.  Very helpful.  Setting the small practice flag works.