Compliance Regulatory Solutions focus on MIPS (Merit-based Incentive Payment System) Performance Categories from CMS.
There are 6 collection types for MIPS quality measures:
- Electronic Clinical Quality Measures (eCQMs)
- MIPS Clinical Quality Measures (CQMs)
- Qualified Clinical Data Registry (QCDR) Measures
- Medicare Part B claims measures
- CMS Web Interface measures
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
In addition, CMS will automatically calculate and score individuals, groups, and virtual groups on two new administrative claims measures (after the case and clinician requirement minimums are met).
- Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate.
- Risk-standardized Complication Rate (RSCR) following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA).
OIG – Office of Inspector General
OCR – The Department of Health and Human Services Office for Civil Rights is in charge of HIPAA enforcement, by auditing healthcare providers and their business associates and handing out fines for noncompliance.
CMS – The Centers for Medicare and Medicaid Services
ONC – Office of the National Coordinator for Health IT
Hospital Accreditation Agencies
- TJC – The Joint Commission
- NIAHC – National Integrated Accreditation for Healthcare Organizations
- NCQA – National Committee for Quality Assurance
- CARF – Commission on Accreditation of Rehabilitation Facilities
- COA – Council on Accreditation