Starting in January, CMS sends each ACO a list of patients to be used for reporting for each measure. These are the “Sample Patients.”

CMS will provide up to 616 patients for each measure. CMS tries to identify and use patients who qualify for multiple clinical domains (measures) and “ranks” them.  A rank of 0 means the ACO does not need to report for this patient for this measure. Other than indicating that the patient is to be reported, the non-zero value of the ranking has no meaning in the Clinigence application.

The Assigment Process:

Clinigence loads the PATB sample patient file into the Registry database.

Based on CMS claims data, each patient is assigned to:

  • 1 practice: The PATB TIN is matched to that in the organization census. For TINs with more than 1 practice the PATB NPIs are matched against the organizational census NPI to identify the specific practice.
  • and 1 provider: The PATB NPIs are matched to those in the organization census.

Optional: If the practice has integrated its EHR with Clinigence or if the ACO provides alternative data feeds, then that clinical data is used to prepopulate the Registry.

Changing the Patient Assignment

If the ACO Administrator finds that a patient should be assigned to a different provider, that change can be performed using the Assignment tab in the GPRO Registry.

  1. Select the patient name from the Registry list. The Patient Summary appears.
  2. Select the Assignment tab. The Assignment screen appears with the current assignments displayed.
  3. If you need to change the practice, select the desired practice from the dropdown list.
  4. If you need to change the provider, select the desired provider from the dropdown list. (Only providers with a relationship to the selected practice will appear in the list.)