INPUT NEEDED: Multiple Submission Scenarios

[Jonathan Sullivan]

I am working with my subject matter colleagues at CMS on an "explainer" regarding scenarios in which data is submitted more than once, whether through different channels or the same channel. For example, "Two different EHR vendors generate QRDA3 files and submit via API for the same TIN/NPI. Will only the latest submission be evaluated?"

If you have similar questions, please reply to this post and I will incorporate them into the explainer. Thanks.

[Ivana Ng]

Hi Paulo -

Apologies for the delayed response. The answer to your question is, "if this scenario created both a [TIN Score] and a [TIN / NPI Score] these would be compared and the higher of two score would be used for the NPI. This would effectively remove the NPI from the TIN from a payment adjustment perspective."

-Ivana

Ivana Ng

Product Manager

Nava

On Wed, Sep 13, 2017 at 1:49 PM, Paulo <pandr...@gmail.com> wrote:

Scenario:

A TIN does group reporting of Quality, IA and ACI with registry A. The QPP API sends for example a score of 70 points to registry A regarding that TIN

An individual provider inside the group above doesn't know that MIPS was already reported under the TIN and uses registry B to report Quality, IA and ACI. The QPP API sends for example a score of 80 points to registry B regarding that NPI/TIN

Does that individual provider get a final score of 80 points or the group score of 70 points?

On Wednesday, September 13, 2017 at 8:17:23 AM UTC-4, Jonathan Sullivan wrote:

I am working with my subject matter colleagues at CMS on an "explainer" regarding scenarios in which data is submitted more than once, whether through different channels or the same channel. For example, "Two different EHR vendors generate QRDA3 files and submit via API for the same TIN/NPI. Will only the latest submission be evaluated?"

If you have similar questions, please reply to this post and I will incorporate them into the explainer. Thanks.

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[abhijeet mahajan]

One more question in extension to the question to this. What if this is done (mostly by mistake I suppose) for multiple providers for the same TIN.

Example : For the combination TIN:0123456, NPI:098765423 score is 80. While For TIN:0123456, NPI:098765421 score is 60. Now for the same TIN, we submit same set of measures as GROUP and the score is 70. 

So if we go as per the higher score theory in this case, payment adjustment will be done on the TIN-NPI score because the score is 80 for the NPI:098765423.

While for NPI:098765421, payment adjustment will be done on the TIN score level. Because that's the higher score. Is this how it will work or it will apply the payment adjustments based on TIN score 70 ?

 

Thanks,

Abhijeet

On Thursday, 5 October 2017 02:15:44 UTC-4, Ivana Ng wrote:

Hi Paulo -

Apologies for the delayed response. The answer to your question is, "if this scenario created both a [TIN Score] and a [TIN / NPI Score] these would be compared and the higher of two score would be used for the NPI. This would effectively remove the NPI from the TIN from a payment adjustment perspective."

-Ivana

Ivana Ng

Product Manager

Nava

On Wed, Sep 13, 2017 at 1:49 PM, Paulo <pandr...@gmail.com> wrote:

Scenario:

A TIN does group reporting of Quality, IA and ACI with registry A. The QPP API sends for example a score of 70 points to registry A regarding that TIN

An individual provider inside the group above doesn't know that MIPS was already reported under the TIN and uses registry B to report Quality, IA and ACI. The QPP API sends for example a score of 80 points to registry B regarding that NPI/TIN

Does that individual provider get a final score of 80 points or the group score of 70 points?

On Wednesday, September 13, 2017 at 8:17:23 AM UTC-4, Jonathan Sullivan wrote:

I am working with my subject matter colleagues at CMS on an "explainer" regarding scenarios in which data is submitted more than once, whether through different channels or the same channel. For example, "Two different EHR vendors generate QRDA3 files and submit via API for the same TIN/NPI. Will only the latest submission be evaluated?"

If you have similar questions, please reply to this post and I will incorporate them into the explainer. Thanks.

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[Ivana Ng]

Yup that's correct. NPI:098765423's score will be 80, NPI:098765421's will be 70.

Ivana Ng

Product Manager

Nava

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[abhijeet mahajan]

Alright. Thanks Ivana !