Million Hearts® Model
Cardiovascular Disease Risk Reduction Model
Q&A from the Data Submission TA Webinar for Control Group Participants
Last Updated: December 2017
Contents
Data Entry, Upload, and Submission
EVAA and Related Statuses
“Pending Acceptance” Status
“Verify HICN” Status
Payment
Miscellaneous
Data Entry, Upload, and Submission
Q. What is the deadline to submit new beneficiary data? Do you have to submit clinical data for the visit?
A. To complete a beneficiary record, you must submitdemographic andclinical visit data. The deadline for submitting beneficiary data for the first performance year is December 31, 2017.
Q. What happens if you still have beneficiaries with incomplete visit or demographic data afterthe deadline of December 31, 2017?
A. After December 31, 2017, you will be unable to submit information for visits occurring between January 3 – June 30, 2017. However, for visits occurring between July 1 – December 31, 2017, you will be able to add information in the MHM Data Registry until the end of March 2018.
Q. Can we continue to enter data for new beneficiary visits in 2018?
A. Yes, you must continue to enroll new beneficiaries in the MHM Data Registry throughout the course of the Model.
Q. Lipid panels are not collected during in-person visits with our practice; beneficiaries are sent to a lab. How should we handle this clinical data item when it comes to data submission?
A. You should wait to submit a beneficiary record in the MHM Data Registry until you have all necessary data to complete the record, including lipid panels. After you receive this information, you can submit all required data for the beneficiary record in the MHM Data Registry.
Q. What if a beneficiary doesnot have a lipid panel but does have an individual LDL and HDL result on the same date of service.Is this beneficiary eligible without a total cholesterol value?
A. The total cholesterol value is a mandatory data field for submitting beneficiary records in the MHM Data Registry. Remember, your organization can obtain cholesterol data from up to 5 years prior if you are unable to obtain a more recent lipid panel.
Q. Please explain how the spreadsheet upload can identify when an updated visit is for the anniversary visit.
A. The MHM Data Registry will indicate when it has been 10-14 months since theinitial visit, and will enter the additional data from your organization as information from an annual follow-up visit.
Submitting data for annual follow-up visits issimilar to the initial enrollment visit. You will collect the same clinical indicatorsand enter this data into the MHM Data Registry via your preferred data upload method.
Q. When entering clinical data manually, the MHM Data Registry does not show my saved beneficiary record as complete. How do I complete a beneficiary record?
A. A record is considered complete when the following mandatory data points are entered:
- Medicare Health Insurance Claim Number (HICN)
- Date of Birth
- First Name
- Last Name
- Gender
- Race
- Ethnicity
- Systolic Blood Pressure
- Total Cholesterol, LDL, HDL
- An attestation to the accuracy of the data.
If you have entered all the above information and completed the attestation to the accuracy of the data and the record is still listed as “Incomplete Record”, please contact the MH Model Help Desk.
Q. There are beneficiaries that do not have total cholesterol, LDL, or HDL. For these beneficiaries to be eligible do their labs need to be completed by December 31, 2017 instead of the 2-month window? Does this only include total cholesterol or does it include LDL and HDL as well?
A. Total Cholesterol, LDL, and HDL are all required data points to complete a beneficiary record. If this information is not available before December 31, 2017, you may need to wait until the patient returns to your organization to obtain the lipid panel. For the time being, you can reject the records that do not have cholesterol available and select the drop-down reason “Cholesterol Unavailable/Out of Range”, which will result with a temporary status. If you are able to collect the cholesterol readingslater on, you will have another opportunity toaccept and complete the same recordby selecting “Accept” under Actions.
Q. Are we supposed to document the fact that clinical data was collected or are we supposed to submit the actual values? The current “Visit Template” does not allow for the values to be reported.
A. You are required to submit the clinical values for each mandatory data field required in the MHM Data Registry. The Excel bulk upload template allows you to input clinical codes to reflect the appropriate clinical information. Please contact the Help Desk if you have further difficulty reporting clinical values through the Excel template.
Q. How do we see the data specifications for the bulk upload?
A. Please review the“Definition File” found in the MHM Data Registry in the Data tab under Resources. This Excel document lists the acceptable values for each parameter.
Q. Prior to realizing that you had provided an Excel worksheet, we created our own. Can that be used?
A. No, the MHM Data Registry will not accept Excel worksheets that are not in the format of the bulk upload template provided.
Q. Can you export MH Model website data to Excel to troubleshoot HICN?
A. Yes, you may export a list of all beneficiary record information by clicking on “Print Beneficiary Grid” on the Data tab in the MHM Data Registry.
EVAA and Related Statuses
Q. What does the “Ineligible”status mean?
A. If a beneficiary record received the “Ineligible” status, the beneficiary did not meet all eligibility criteria for the MH Model at the time of enrollment.
Q. How do we learn why a beneficiaryreceived an “Ineligible” status?
A. Previously, the MHM Data Registry functionality that was intended to provide a reason why the beneficiary is marked as “Ineligible” was not working properly. We have since fixed this issue, and you should now be able to view reasons for ineligibility in the MHM Data Registry on the Beneficiary and Clinical Information Form.
“Pending Acceptance” Status
Q. We received about 300 “Pending Acceptance” records that we do not believe we have seen. How were these records identified and what was the cutoff date?
A. During the validation and alignment process, these beneficiaries were identified using CMS claims data as eligible for the MH Model and seen by your organization betweenJanuary 3 – June 30, 2017, but were not enrolled in the MHM Data Registry.
Q. What is the criteria for accepting or rejecting “Pending Acceptance” records?
A. When reviewing a “Pending Acceptance” record, you should review the HICN provided and determine if you have the necessary demographic and clinical information to complete the beneficiary record in the MHM Data Registry.
If you have the necessary demographic and clinical information to complete the record, you should accept the record.
If you feel the beneficiary is ineligible for the MH Model, you may reject the record and select the appropriate reason code.
If you do not have the necessary information to complete the record, you may wait to accept the record until the beneficiary has another visit with your organization (even if this occurs during the second performance year), at which point you can accept the record and enter all necessary data to complete the record in the MH Data Registry.
Q. Can other data besides the HICN be supplied for “Pending Acceptance” records that will identify the beneficiary, as we can’t always find the beneficiary through just the HICN?
A. The HICN is the unique identifier used for validating information in the MHM Data Registry with CMS claims data, and, therefore, is the information the MH Model Team is able to provide for Pending Acceptance records at this time. We encourage you to coordinate across your organization to identify additional demographic information for the beneficiary. If are unable to identify the beneficiary, you may leave the record as “Pending Acceptance” until the beneficiary has another visit with your organization (even if this occurs during the second performance year).
Q. If I cannot identify beneficiary by their HICN do I reject that beneficiary?
A. No,if are unable to identify the beneficiary, you may leave the record as “Pending Acceptance” until the beneficiary has another visit with your organization (even if this occurs during the second performance year).
Q. Is there a way to mass accept or mass reject the HICN instead of individually?
A. No, you must manually accept or reject “Pending Acceptance” records. The MH Model Team understands from participant feedback that this functionality interrupts your workflow and is not feasible for some organizations. We are currently assessing improvements for the spring 2018 EVAA cycle and are looking into options that will make this process less burdensome for your organizations.
Q. Would you clarify, we cannot bulk accept records but we can bulk upload data for the records we accept?
A. That is correct. After manually accepting records, as applicable, you may utilize the bulk upload templates to complete the demographic and clinical data for these records in the MHM Data Registry.
Q. What will happen if we do not submit our data and respond to the “Pending Acceptance” records by December31, 2017?
A: You may wait until after December 31, 2017 to take action on “Pending Acceptance” records, although you will not be able to count these pending acceptance beneficiary records towards your 90% enrolled threshold and payment for those records may be delayed.
Q. What reason code should we use to reject a “Pending Acceptance” beneficiary that is over the age of 79?
A. For these situations, you may reject the beneficiary and select the reason “One-Time Encounter/Will Not Return for Follow Up.”
Q. While accepting beneficiaries, I rejected ineligible beneficiaries because they were not our clinics beneficiaries or are not eligible due to medical conditions. Is there more I need to do?
A. No additional action is required from your organization for those records at this time.
Q. If “Pending Acceptance” beneficiaries have a history of myocardial infarction or coronary artery disease that excludes them from the Model, should we reject them?
A. You may reject these beneficiaries and select the reason code “Prior heart attack or stroke.”
“Verify HICN” Status
Q. We have beneficiaries with invalid HICNs but the MHM Data Registrywill not let me remove them because they had visits from a previous reporting period. How should those be handled?
A. Records with a “Verify HICN” status can be corrected by your organization as the current HICN could not be identified in the claims data. Please proceed with updating the HICN through the MHM Data Registry. If these are not addressed after 2 consecutive performance periods (by end of June 2018), the model team will remove them on your behalf.
Payment
Q. When will we receive payment after data has been submitted for this first performance year?
A. The first round of MH Model payments were dispersed in December 2017 for records that were validated in the October 2017 EVAA cycle. Any organizations who submitted validated data between January-June 2017 and have not yet received payment have been contacted individually by the model team with related details. All first performance year data will be validated in April 2018, and applicable payments will be dispersed in May 2018.
Miscellaneous
Note: For specific questions regarding data entry or EVAA results, please contact the MH Model Help Desk with an encrypted file that includes applicable screenshots and/or beneficiary record information for our team’s investigation. You must then call the MH Model Help Desk with the password to this file.
Q. Would you repeat the three items we are to submit to the MH Model Help Desk if we need help troubleshooting our data upload?
A. If you would like to request a technical assistance phone call to discuss data entry issues, contact the MH Model Help Desk and provide the below information:
- Upload method (e.g., Excel or CCDA)
- Supplemental screenshots as available (be sure they do not contain any sensitive information)
- Error log and error file – both files must be encrypted and you must call the MH Model Help Desk to provide the password
- Date of the upload error
Q. What is a Corrective Action Plan?
A. A Corrective Action Plan (CAP) is issued to your organization when you are not meeting one or more of the MH Model requirements, as stated in the Model Participation Agreement (MPA). If you do not fulfill all Model requirements, you will be asked to coordinate with your MHPO to determine a plan for meeting the outstanding requirement(s) moving forward. Once you submit a write up of this improvement plan to your MHPO, you can continue with your participation in the Model. A requirement to submit a CAP does not impact your status with Medicare and is not publicly available information; rather, this is an internal mechanism used to ensure requirement compliance and program integrity.
Q. If a provider leaves, how can we update the MHM Data Registry to reflect that change and list the new provider?
A. If you would like to remove a provider from the MHM Data Registry and there are currently beneficiaries assigned to that provider, please submit a MH Model Help Desk ticket to with the following: 1) an encrypted file containing the list of HICNs aligned to the NPI that is being removed, and 2) provide the alternate NPI for the records. After emailing the encrypted file and receiving your ticket number, call the MH Model Help Desk with the associated password and provide the ticket number for reference. We will notify you when these updates are complete.
Q. What if the physicianbeneficiaries have seen is not from our 20 elected providers?
A. If the patient did not see one of your participating providers, then they cannot be enrolled into the model. Please review your practitioner list in the MHM Data Registry to make sure it is accurate and up-to-date.
Q: How will the change in Medicare ID numbers impact the MHM Data Registry?
A: CMS will be rolling out the new Medicare cards with the Medicare Beneficiary Identifier (MBIs) in April 2018. We are in the process of creating MH Model training materials for this and updating current materials that will be impacted. You will see updates to the MHM Data Registry in April 2018. Please also be on the lookout for training materials on this after the New Year.
1