The Centers for Medicare & Medicaid Services (CMS) has given its Quality Improvement and Evaluation System (QIES) a makeover. The system is used by providers and vendors to submit OASIS assessment data.
The enhancements are meant to make the system more reliable, scalable, secure, accessible and Cloud-based. They will occur in phases by provider type, starting with Home Health Agencies (HHAs) in January 2020. The changes include an updated name: the Internet Quality Improvement and Evaluation System (iQIES). Beginning January 1, HHAs must submit their OASIS files to iQIES or risk claim rejections and payment disruptions.
QIES includes the Assessment Submission and Processing (ASAP) System, Certification and Survey Provider Enhanced Reports (CASPER) and the Automated Survey Processing Environment (ASPEN) system. It collects and validates data on provider- and beneficiary-specific care and performance outcomes. CMS uses QIES data to improve the quality and cost-effectiveness of services paid under the Medicare and Medicaid programs. The iQIES system enhancements will not change how providers currently submit data to CMS. CMS implemented the enhancements after research and testing to determine user needs and validated designs. Modern system design practices including human-centered design and agile development practices have been incorporated to enable a phased development and delivery approach. Cloud-based solutions will be introduced to offer better support and an improved interface.
iQIES system enhancements include:
- System access no longer requires a virtual private network (VPN) or CMSNet. iQIES is Internet-facing and maintains the latest system architecture and security standards.
- System enhancements support flexible, user-friendly data reports for providers, which makes it easier to use real-time data for care planning and quality monitoring and improvement purposes.
- Users can access important information for work anywhere, at any time, on any device, thanks to built-in adaptability with increased accessibility.
iQIES, PDGM and OASIS-D1 all begin January 1. Under PDGM, iQIES will be critical for OASIS submissions going forward. Under PDGM, the grouper will only capture the functional score from the last OASIS assessment that was transmitted to iQIES. No other data will be captured from the OASIS assessment itself. The scores for the functional items will then be combined with claims data (diagnoses, early/late, and source of admission) to determine a HIPPS code.
In the next few weeks, providers must take a few critical steps in order to ensure access to iQIES. According to a posted warning from CMS: “Please note that failure to obtain access to iQIES prior to December 23, 2019, will impact your ability to submit assessment data needed for payment purposes, as the system will have a scheduled downtime so that the data migration can occur in preparation for the January 1, 2020, release.”
Specifically, before December 23, HHAs should take the following steps and tips from Palmetto GBA to receive access to iQIES:
- Create an account and establish credentials in the Healthcare Quality Information System (HCQIS) Access, Roles and Profile system (HARP). HARP is a secure identity management portal that the Centers for Medicare & Medicaid Services (CMS) provides. Users will need to select an iQIES role.
- Identify an individual as your Provider Security Official (PSO).
- Register the PSO in the Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP) system at: https://harp.qualitynet.org/register/profile-info.
- After your multi-factor authentication is complete, choose the iQIES application presented to you to request your Security Official role. You also can access iQIES at the following URL: https://iqies.cms.gov/ to complete your role request.
If eSolutions submits your OASIS files to CMS on your behalf, you still need to take the above steps. Once completed, you will need to contact eSolutions Support with your CCN so we can request access to submit on your behalf. Call support at 866-633-4726 (option 1) or create a ticket. After eSolutions requests access, your PSO will receive an email informing you of the request. The PSO must then login and agree to this access. eSolutions clients can expect some changes to prepare for PDGM, iQIES and OASIS. You’ll see changes to the reports we provide and product enhancements to support users as you transition to this model.
If you don’t obtain access to iQIES by December 23, it will negatively affect your HHA’s ability to submit assessment data needed for claims matching purposes after January 1, 2020. Claims that can’t be matched to assessments will be returned to the HHA, which will cause problems for your Medicare payments.