MACRA Monday: Poor HbA1c control


If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Limelight Video

Measure #1: Diabetes: HbA1c Poor Control

The measure is aimed at capturing the percentage of patients aged 18-75 years with diabetes who had a hemoglobin A1c greater than 9.0%. For this inverse measure, a lower performance rate indicates better clinical care.

What you need to do: Document the patient’s most recent HbA1c level that was performed during the last 12 months.

Eligible cases include patients aged 18-75 years on the date of the encounter who had a documented diagnosis of diabetes. One of the following services must be performed at the visit (CPT or HCPCS): 97802, 97803, 97804, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0270, G0271, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or that you had a good reason for not doing so. For instance, CPT II 3046F indicates that the most recent hemoglobin A1c level was greater than 9.0%, CPT II 3044F indicates that the most recent HbA1c level was less than 7.0%, and CPT II 3045F indicates that the most recent HbA1c level was between 7.0% and 9.0%.

CMS has a full list of measures available for claims-based reporting at The American Medical Association also has created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.

• Those who have Medicare Part B allowed charges of $30,000 or less.

• Those who have 100 or fewer Medicare Part B patients.

• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

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