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  • MIPS 2023—PI: The Health Information Exchange (HIE) Objective

    This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.

    With this objective, you select one of three options (up from two options in 2022).

    Option 1: report your performance rate(s)—or claim the exclusion(s)—for the two Support Electronic Referral Loops measures.

    Option 2: attest that you performed the HIE Bi-Directional Exchange measure (this option is unlikely to apply to private ophthalmology practices).

    New for 2023—option 3: report on the Enabling Exchange Under the Trusted Exchange Framework and Common Agreement (TEFCA) measure.

    What is TEFCA? TEFCA features a technical infrastructure model that is intended to provide a minimum level of interoperability, thus helping users to exchange clinical information securely. Qualified Health Information Networks (QHINs) are being encouraged to sign an agreement that promotes the use of TEFCA.

    The new TEFCA measure. This new measure involves signing a Framework Agreement, connecting directly to a QHIN (or connecting to an entity that connects to a QHIN), and using CEHRT to support secure, bidirectional exchange of patient information in accordance with TEFCA.

    Exclusions. For the HIE objective, only the two Support Electronic Referral Loops measures have exclusions.

    • Exclusion for the Support Electronic Referral Loops by Sending Health Information measure. Exclusion: “Any MIPS eligible clinician who transfers a patient to another setting or refers a patient [a combined total of] fewer than 100 times during the performance period.”
    • Exclusion for the Support Electronic Referral Loops by Receiving and Reconciling Health Information measure. Exclusion: “Any MIPS eligible clinician who receives transitions of care or referrals or has patient encounters in which the MIPS eligible clinician has never before encountered the patient [a combined total of] fewer than 100 times during the performance period.” (Note: It is unlikely that a large practice would fall below this threshold over 90 days.)

    If you claim exclusions for both of the Referral Loops measures, the points associated with them would be redistributed to the Provider to Patient Exchange objective.

    No exclusions for options 2 or 3. CMS didn’t provide exclusions for the HIE Bi-Directional Exchange measure or the TEFCA measure because you can report (or claim exclusions for) the two Referral Loops measures instead.

    Tip: If your EHR system is a CEHRT, it must provide you with a HIPAA-compliant Direct messaging service that supports the referral loop measures. Ask your vendor for your clinicians’ direct addresses (or electronic end point) and add them to their National Plan and Provider Enumeration System (NPPES) profiles. For more information, see “MIPS 2021—How to Boost Your Promoting Interoperability Score” (EyeNet, August 2021).

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