Quality Program Enrollment

athenaClinicals + athenaOne for Hospitals & Health Systems

You can update your own program enrollments rather than requesting updates through the support case process. Users with the Clinicals Admin: Quality Manager Admin role or the Program Enrollment: Quality Manager permission can adjust enrollments by individual provider or measure and in bulk on the self-serve Program Enrollment page. Saved changes will reflect in athenaClinicals within two hours^*. This feature is available for your providers who wish to manage their own enrollments within the following programs:

• Accountable Care Organizations (ACO) Web Interface (General Population and MSSP)
• Healthcare Effectiveness Data and Information Set (HEDIS)
• MIPS Group and MIPS Group (Not for Attestation)
• MIPS Individual and MIPS Individual (Not for Attestation)
  • Uniform Data Systems (UDS)
• Patient-Centered Medical Home (PCMH)
• Patient-Centered Specialty Practice (PCSP)
• PI Medicare
• Pharmacy Quality Alliance (PQA)

Notes:

• For PCF enrollment prerequisites, read this O-help topic: To enroll in the Primary Care First program.

• *In cases of excessive unenrollments, those unenrollment changes and any further changes made on the same day will be reflected in athenaClinicals in 24 hours.

• You can enroll your practice in the MIPS Not for Attestation programs using the self-serve Program Enrollment page.

• Once enrolled, athenahealth will automatically roll over providers year to year.

• If providers or groups are inactive, athenahealth may automatically unenroll from any MIPS submission (a.k.a. For Attestation) programs. An inactive status, for the purposes of MIPS automatic unenrollment, may be determined when no encounter or claim has been processed in athenaOne for a minimum of 21 months for an individual provider and 33 months for a MIPS group.

Automatic MIPS Enrollment

Individual clinicians with a "MIPS Eligible as an individual" status are automatically enrolled in MIPS Individual for attestation program for each performance category after the first clinical encounter. We leverage the publicly available data from CMS' Quality Payment Program (QPP) to make that determination for individual eligible clinicians. This is performed as a safety net by athenahealth to reduce the risk that new providers will be penalized for not submitting data.

 

While auto-enrollment happens under certain conditions, the self-serve Program Enrollment page is always available and has these advantages:

• Allows you to select only desired quality measures, vs system defaults.

• Allows for enrollment as an individual, as a group, or both.

• Allows for enrollment in the MIPS Not for Attestation option for those that would prefer athenahealth not submit on your behalf.

• Allows for enrollment by providers that are currently ineligible or opt-in eligible. This includes providers reporting under a new TIN, where QPP may not publish eligibility until Nov/Dec for the current year, which is too late to drive performance in measures.

• Reduces the risk of relying on an automated process where the process is sometimes unable to reconcile/match providers in athenaClinicals with QPP.

• Allows for timely enrollment by not waiting on encounters, claims to Medicare, or for the eligibility script to run that may assist clinicians in being notified of care gaps and/or receive communications or awareness in quality dashboards that other actions may be required, like Registration of Intent for Public Health Registries.

Additional MIPS Enrollment Details

MIPS Eligibility is determined by the CMS and is published at QPP Eligibility Lookup. See the MIPS Program Eligibility FAQ for more information.

 

athenaOne offers two type of enrollments that may be selected for each of the MIPS performance categories: Quality, Promoting Interoperability (PI), and Improvement Activities (IA):

1. For Attestation (FA) Default submission program

   • Measures will appear on the MIPS Dashboard as well as other quality tools like the Quality Management Report, eCQM Data Report, Quality Tab in chart, etc]

   • Choose if you want athenahealth to submit data on your behalf.

2. Not-for-Attestation (NFA)

   • Measures will appear in quality tools, except MIPS Dashboard.

   • athenahealth will not submit data. Providers can self-submit or simply monitor results, for example in the Quality Management Report.

   • Consider if ineligible or opt-in eligible and submission is not desired.


Two scenarios that require enrollment through the case process are:

• For MIPS PI, a specific 90 day-quarter may be requested.

• For MIPS PI Not for Attestation, a custom date range or rolling 90-day program may be requested.

MIPS eCQM and CQM measures

• MIPS Quality measures with a measure ID that begins with "CMS" are electronic Clinical Quality Measures. New providers may enroll in the measures and they can aggregate results from a previous EHR if they are reporting under the same TIN.

• MIPS Quality measures with a measure ID that doesn't begin with "CMS" are MIPS Clinical Quality Measures. These measures require an encounter to be documented on January 1st of the current year or before so new providers are likely unable to enroll in these measures in the default program (For Attestation).

• New providers can enroll in the Not-for-Attestation program to assist with monitoring performance until they can enroll in the default For Attestation program their second year.

How to use Program Enrollment

At a high-level, self-serve Program Enrollment is a two-step process:

1. Activation: First you "activate" which programs and which measures you want to make available for enrollment by checking the box under the Activate columns on the initial Program Enrollment page. Save your activations.

2. Enrollment: Then you click Enroll to proceed to the Enrollments Setup page where you connect providers with measures (or measures with providers).

If you don't see the measure(s) you're looking for on the setup page, you probably need to "activate" it first. Most changes are effective within two hours (bulk unenrollments may take up to 24 hours).

 

To confirm enrollment, use one of the following methods at least two hours after saving changes:

• Quality > Pay for Performance Dashboard: Select a program and drill down to verify the list of providers and view the number of measures for each. Click the number of measures to see the list of enrolled measures.

• Reports > Report LIbrary > Clinicals > Cross-Practice Quality Program and Clinical Guideline Enrollment Report

Accessing the Program Enrollment page

From the Quality menu in athenaClinicals, under Quality Setup, select Program Enrollment. The Program Enrollment page looks like this:

The Program Enrollment home page is divided into two panels: Programs list on the left and the Measures list on the right. This is the page where you "activate" which programs and measures you want to participate in. Above the Measures list on the right is the Specialty filter that lets you filter the measures to relevant specialties for your practice.

Programs list

The Programs list is sorted alphabetically by default. Under the Activate column, check the box for each program you want to participate in. Here's a closer look:

Once you select a Program from the left, the Measures list on the right refreshes with the appropriate measures corresponding to the programs selected. Next you can select which measures you want to make available for enrollment in the Measure list on the right.

Measures list

The Measures list in the right panel sorts measures alphabetically. Under the Activate column, check the box for each measure you want to makeenroll into. Activating the measure here makes it available for enrollments on the next page. Clicking the Activate column header sorts the measures based on the Activation state and also allows you to bulk select the measures.

 

When a program is activated, any mandatory measures of the program are automatically selected in the Activate column for your convenience. The measure set shown in the Measures list is based on the program(s) selected.

 

Once you've selected the measures you want to make available for enrollment, click the Save Activation button in the upper right to save your selections.

Now click Enroll, in the Program list on the left under the Enrollment column, to advance to the Enrollment Setup page.

Enrollment Setup page

The Enrollment Setup page is where you make adjustments to your enrollments. This page continues the two-panel display with information on the left corresponding to information displayed on the right.

There are two tabs at the top of the Enrollment Setup page. The Providers tab and the Measures tab do the same thing. The two tabs are there for your personal preference—do you prefer to tackle the task of enrollments by going through the list of your providers, or do you prefer to adjust by measures—the option is yours.

Providers tab

The Providers tab lists the providers within your practice on the left with the measures they're already enrolled in on the right. Here's a closer look at a provider's list of MIPS Individual PI measure enrollments:

To add a measure to a provider's enrollment, you'll click Add Measure. The Add Activated Measures window opens:

You can search for a measure or filter by specialty to find the one you want. You'll check the box beside any additional measures to add to the providers enrollment and then click Add.

Bulk enrollments

You also have the option to copy selected measure enrollments from one provider to another provider, in bulk. This is a huge time saver. Say you've enrolled a provider in five additional measures. Next, you need to do that same task for 10 more providers in your practice! Now you can select the measures, click Copy Selected...

...select another provider from the left panel, and then click Paste Selected.

Click Save. Bulk enrollment adjustments are also available on the Measures tab.

Measures tab

The Measures tab lists all the measures within that program on the left, and the providers already enrolled in that measure on the right. Here's the left half of the Measures tab,

To enroll a provider in a measure, you'll click Add Provider. The Add Providers window opens. Note in this screenshot that the measure already has two providers enrolled in it:

You can search for a provider, filter by specialty, or filter by TIN to find the provider you want. You'll check the box beside the providers to enroll in the measure and then click Add.

 

Bulk enrollment is also available from the Measures tab. With a measure in focus in the left panel, you can select, copy, and then paste providers from other measures with existing enrollments.

 

Alerts

There are plenty of guardrails in place to coach you through self-serve enrollments.

Error alerts:

These alerts indicate that your enrollments currently do not meet the program requirements and need correction before you can see them in dashboards, reports and patient charts. Some examples include:

• MIPS Quality requirement unmet - Include at least six measures (including a high priority measure).

• MIPS PI requirements unmet - Include mandatory measures:

  • e-Prescribing excluding controlled substances OR
  • e-Prescribing including controlled substances

Warning alerts:

These alerts indicate that you are not meeting certain best practices, but these enrollments will be available in dashboards, reports, and patient charts. Some examples include:

• MIPS IA Recommendation - we recommend including all activities.

Each alert provides guidance on how to fix the invalid enrollment. Any pre-existing invalid enrollments will be cleaned up by the system and will require corrections before you can see them back in the reports/dashboards.

User access and permissions

You must have Clinicals Admin: Quality Manager Admin role to access this functionality. The permission within the Clinical Admin: Quality Manager Admin role that specifically gates access to the Program Enrollment page is Program Enrollment: Quality Manager.