QPP APM Entity

Data Sources

The APP only requires ACO's to report on 3 measures, however measures are reported in the MIPS CQM (Clinical  Quality Measure)

The following are data imports available for the QPP APM Entity

Year-Round Data Import Options

QRDA I

QRDA is a Clinical Document Architecture (CDA)-based standard for reporting patient quality data for one or more quality measures. QRDA is designed to have those data elements needed for quality measurement.

If Cerner, Epic or  Allscripts

SMART on FHIR

FHIR is a Health Level 7 (HL7) standard for exchanging healthcare information electronically. FHIR creates a common set of APIs so healthcare platforms can communicate and share data in a manner that each platform can understand.

Import Medicare

HALR/QALR

Patient rosters and claims data. Use Medicare claims data to identify patients with qualifying encounter

APM Entity: Medicare Patient Workflow

Import Commercial

Patient rosters and claims data. Use Claims data to identify patients with qualifying encounter

APM Entity: Non-Medicare Patient Workflow

Medicare Claims

CPT II Codes

Populate quality measure answers using QDC codes in claims, per CMS specs for MIPS CQM. CPT Category II codes and HCPCS Level II G codes make up the Quality Data Codes (QDC) codes.

Data Received from Medicare on a montlhy basis

APM Entity: Non-Medicare

Patient Workflow

(Commercial Patient Rosters not available)

End-of-Year Data Reporting Option

QRDA III

Quality Reporting Document Architecture in a summary numerator/denominator level quality report.

Meet with Internal IT or EHR Vendor
Generate QRDA Category I Files
Determine the QRDA
submission frequency
Drop QRDA files
to Health Endeavors' SFTP or send via Submit a Request
Health Endeavors' QRDA import runs twice a month
  • Claims (QDC Codes per MIPS CQM)

    • Populate quality measure answers using QDC codes in claims, per CMS specs for MIPS CQM. CPT Category II codes and HCPCS Level II G codes make up the Quality Data Codes (QDC) codes.

    • Data received from Medicare on a monthly basis.

  • QRDA Files

               QRDA is a Clinical Document Architecture (CDA) - based standard for reporting patient quality data for one or                 more quality measures. QRDA is a CDA-based standard designed to have those data elements needed for                       quality measurement.

                 - QRDA Category I (Single Patient Report) Individual patient-level report that contains data defined in the                            measure.

               QRDA I Workflow:

                

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  • FHIR - (Fast Healthcare Interoperability Resources) 

               FHIR is a Health Level Seven International (HL7) standard for exchanging healthcare information electronically.                 FHIR creates a common set of APIs so healthcare platforms can communicate and share data in a manner that                   each platform can understand.​

  • Manual Entry

             Manually enter quality measure answers in Health Endeavors.