In the MIPS program, the Advancing Care Information (ACI) category replaces the Medicare Electronic Health Records (EHR) Incentive Program (Meaningful Use) and is intended to promote patient engagement and the electronic exchange of information using certified EHR technology (CEHRT). MIPS-eligible clinicians may earn a score of up to 155 points but any score above 100 will be capped at 100 points.
The ACI score is the combined total of the following three scores:
1. 50 points: Required Base Score
2. 90 points: Performance Score
3. 15 points: Bonus Score (up to 15 points)
The bonus and performance scores are added to the base score to get the total ACI score. The ACI total score is multiplied by the 25% ACI category weight with the result added to the overall MIPS final score.
Example: If a MIPS-eligible clinician receives the base score (50 points), 40 points for their performance score and no bonus score, they would earn an ACI score of 90 points. When weighted by 25%, this would contribute 90 X 0.25 = 22.5 points to their overall MIPS final score.
Clinicians must use Certified Electronic Health Record Technology (CEHRT) to qualify for reporting ACI information. Qualifying clinicians may choose from a variety of methods for submitting ACI measures:
CMS Web Interface (groups of 25 or more)
CMS will automatically reweight certain clinicians based on their special statuses. MIPS-eligible clinicians and groups may also submit a hardship exception application for one of the following specified reasons:
Insufficient internet connectivity
Extreme and uncontrollable circumstances
Lack of control over the availability of Certified EHR Technology (CEHRT)
If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:
Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
Practice or hospital closure
Severe financial distress (bankruptcy or debt restructuring)
EHR certification/vendor issues (CEHRT issues)
You must submit an application to CMS by December 31, 2017, to reweight the ACI category to 0 if they do not automatically qualify for a reweighting. Qualifying clinicians can choose to report ACI if they wish and CMS will score their performance and weight their ACI performance.
Note: CMS recently published an Interim Final Rule with Comment that provides guidance for MIPS eligible clinicians who live or practice in areas affected by Hurricanes Harvey, Irma, or Maria, or the Northern California wildfires. For more information, please review the Extreme and Uncontrollable Circumstances Policy for MIPS in 2017 Fact Sheet and the Interim Final Rule with Comment.
Options for ACI Reporting using CEHRT
There are two measure sets for reporting:
Advancing Care Information Objectives and Measures
2017 Advancing Care Information Transition Objectives and Measures
Your choice of measure set is determined by your CEHRT edition:
If your EHR system is certified to the 2014 Edition you must use the ACI transition measures.
If your EHR system is certified to the 2015 Edition, or is a combination of technology from both 2014 and 2015 editions, you may choose either set.
A complete listing of all 15 ACI Measures and 11 ACI Transition Measures is available here.
Clinicians must fulfill the requirements of all the base score measures to receive the full 50 points base score; if they don’t they will get a 0 in the overall ACI category. Base score measures are denoted by the Required for Base Score column in the ACI Measures spreadsheet.
For 2017 there are five base score ACI Measures, and four base score Transition Measures (depending on CEHRT Edition 2014 or 2015). The base score ACI Transition Measures are
Security Risk Analysis
Provide Patient Access
Health Information Exchange
Provide Patient Access and Health Information Exchange are also Performance Score measures.
Security Risk Analysis is yes/no measure and the remaining measures are performance rates. To receive 50 points eligible clinicians must submit yes for the security risk analysis measure, and at least a 1 in the numerator for the remaining measures.
Example: using the ACI Transition Objectives and Measures, a clinician will receive a base score of 50 points if he/she:
Conducted a security risk analysis (Security Risk Analysis)
Submitted at least one permissible prescription using CEHRT (e-Prescribing)
For at least one patient, provided timely access to their health information (Provide Patient Access)
For at least one patient, used CEHRT to create and electronically transmit a summary of care record for a transition of care or referral (Health Information Exchange)
Partial and Full Scoring occurs when submitting more than the base measures (i.e. submitting performance and bonus measures). Some of the base score measures can also contribute towards the performance score e.g. Provide Patient Access and Health Information Exchange transition measures.
The performance score is calculated using the numerators and denominators submitted for performance rate measures, or by assigning full credit for yes responses to attestation measures. The maximum performance score is 90 points. For each measure with a numerator/denominator, the score is determined by the performance rate. Most measures are worth a maximum of 10 percentage points, except for two measures reported under the 2017 Transition measures, which are worth up to 20 percentage points. Clinicians may report up to seven optional 2017 ACI Transition performance score measures, in addition to the four base score measures.
Performance Rates for Each Measure Worth Up to 10%
Performance Rate 1-10 = 1%
Performance Rate 51-60 = 6%
Performance Rate 11-20 = 2%
Performance Rate 61-70 = 7%
Performance Rate 21-30 = 3%
Performance Rate 71-80 = 8%
Performance Rate 31-40 = 4%
Performance Rate 81-90 = 9%
Performance Rate 41-50 = 5%
Performance Rate 91-100 = 10%
Example: If a MIPS-eligible clinician submits a numerator and denominator of 85/100 for the Patient Specific Education measure, their performance rate would be 85%, and they would earn 9 out of 10 percentage points for that measure.
Performance score measures are denoted by values greater than zero in the Performance Score Weight Column of the ACI Measures spreadsheet.
Clinicians can earn 5 bonus points by reporting yes to at least 1 additional public health and clinical data registry reporting measure beyond the Immunization Registry Reporting measure. The available measures are
Syndromic Surveillance Reporting (both measure sets)
Specialized Registry Reporting (ACI Transition Measure Set)
Electronic Case Reporting (ACI Measure Set)
Public Health Registry Reporting (ACI Measure Set)
Clinical Data Registry Reporting (ACI Measure Set)
Bonus measures are denoted by the text in the Measure Description column of the ACI Measures spreadsheet.
Clinicians can also earn 10 bonus points by reporting yes to the completion of at least 1 of the specified Improvement Activities using CEHRT.
Clinicians meeting both requirements get a total of 15 bonus points.
Group Reporting ACI Scores
For group reporting, the group combines their performances under one Taxpayer Identification Number (TIN).
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