In January, CMS will make available a list of "sample" patients for each ACO to be used for reporting for each measure. Clinigence will download this file from the CMS GPRO Web Interface to populate the patient lists and assign each patient to a practice and provider, when possible.
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 sample patient file into the Registry database.
Based on CMS claims data, each patient is assigned to:
- 1 practice: The TIN is matched to that in the organization census. For TINs with more than 1 practice the NPIs are matched against the organizational census NPI to identify the specific practice.
- and 1 provider: The 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 Clinigence ACO Registry.
- Select the patient name from the Registry list. The Patient Summary appears.
- Select the Assignment tab. The Assignment screen appears with the current assignments displayed.
- If you need to change the practice, select the desired practice from the dropdown list.
- 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.)